Why The ALF Appliance? Part 5

Dear Colleague,

It is logical to look for the cause of malocclusion if we wish to correct its effects. As clinicians, we are not able to do much about heredity, but from birth onwards, there are opportunities to influence craniofacial growth.

Fig 1 is drawn from a bigger montage of newborns. It reminds us just how distorted the cranium and face can be at birth. Pediatricians see faces like this routinely and may decide to intervene. For more severe cases the favourite resource is a customized helmet which is worn over several months, moulding the cranium into a more balanced shape.

By correcting the plagiocephaly early, they also may create a more balanced facial appearance. There is a strong tendency to assume that the facial disharmony will self-correct with the pressure from suckling. This can happen, but if there are difficulties with latching onto the breast, restriction of tongue movement due to a tongue-tie or blockage of the airway in some way this self-correcting mechanism may not be effective.

Osteopaths have a long history of treating such cranial displacements and are advocates for manual adjustment of the cranium. Cranial flexibility is at its most dramatic at birth to permit delivery, but there are many hazards along the way such as prolonged labour, breech birth, cord around the neck, torticollis, forceps delivery, tethered oral tissues, etc. which can influence craniofacial anatomy. They are best dealt with immediately after birth or as soon after that as possible.

Prigogine defined a live organism as "a non-linear, complex, dynamic, self-organizing system, far from equilibrium"—a definition widely accepted in biology. One characteristic of such a system is "an extreme sensitivity to initial conditions" meaning that a small adjustment early in development will produce a much larger difference of outcome at a later stage. Along with this definition, we have to remember that the body is a biotensegrity structure. Any adjustment to such a structure is absorbed, and its effect is spread immediately through all the rest of the body. These two characteristics of living tissue are very powerful arguments supporting early intervention, in this case without the involvement of any instrumentation or orthodontic device.

There is yet another advantage from such a hands-on approach. The osteopath has a direct sense of the response of the craniofacial structure to the intervention and can modify her hand pressure, maintaining a suitable level of force to enable the body to respond. The problem for orthodontists is that at present this concept lies far outside their comfort zone and the parameters of their experience. However, given the challenges presently facing the orthodontists, there has to be recognition of change or be swept away along with the old concepts of Newtonian mechanics. 

Gavin

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