Management of Cleft Palate in Puppies Using A Temporary Prosthesis: A Report of Three Cases - MDPI
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veterinary
sciences
Case Report
Management of Cleft Palate in Puppies Using A
Temporary Prosthesis: A Report of Three Cases
Theresa Conze 1, *, Isabelle Ritz 2 , Rainer Hospes 1 and Axel Wehrend 1
1 Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals with Ambulatory Service,
Faculty of Veterinary Medicine, Justus-Liebig-University, 35392 Giessen, Germany;
rainer.hospes@vetmed.uni-giessen.de (R.H.); axel.wehrend@vetmed.uni-giessen.de (A.W.)
2 Department of Veterinary Clinical Science, Small Animal Clinic, Surgery, Justus-Liebig-University,
35392 Giessen, Germany; mail@isabelle.ritz.de
* Correspondence: theresa.conze@vetmed.uni-giessen.de; Tel.: +49-641-9938-707
Received: 26 May 2018; Accepted: 20 June 2018; Published: 24 June 2018
Abstract: Cleft palate in dogs is a congenital defect that mostly leads to euthanasia of the affected
puppy. If an attempt is made to raise the puppy, it is generally fed via an orogastric tube. Here,
we describe the management of cleft palate in three puppies (two Boxers, one Collie) using a
customised temporary prosthesis, which allowed the puppies to be bottle-fed and successfully
raised by their owners (Cases 2 and 3) and the author (Case 1). The temporary palatal prosthesis was
manufactured from a mouthguard intended for human children, which is made of thermoplastic
silicone. The preparation procedure was simple and cost-effective. All puppies underwent corrective
surgery at 5–6 months of age. After surgery, one of the Boxer puppies showed mandibular
mesioclusion, while the other two showed no aberrations. All puppies gained the same amount of
weight as their littermates, although the weight gain of the two Boxers was slower than that of their
littermates. In summary, this case report describes an easy and effective way to raise puppies with
cleft palate until corrective surgery can be performed.
Keywords: cleft palate; palatoschisis; puppy; temporary prosthesis
1. Introduction
Palatoschisis, also known as cleft palate (CP), is a craniofacial defect characterised by an abnormal
communication between the oral and nasal cavities and is one of the most common craniofacial
defects in dogs [1–3]. Because of this abnormal connection, suckling is impaired and the risk of
aspiration pneumonia is high [4]. The only successful treatment for CP is corrective surgery, which is
best performed once maxillofacial growth has slowed down or ceased completely [5]; Fiani et al. [5]
recommend an age of about 4–6 months [5]. If corrective surgery is performed earlier than the
recommended age, there is a high risk of dehiscence and maxillary growth delay [5]. However,
raising puppies until the appropriate age for corrective surgery is challenging, and most puppies are
euthanised because of the costs and intensive care required. Neonates that are raised until an age
appropriate for surgery are mostly fed by an orogastric tube [6].
In the present report, we describe the successful management of CP using a customised temporary
prosthesis in three puppies, and demonstrate an easy and affordable way to raise puppies with CP
until corrective surgery can be performed.
Vet. Sci. 2018, 5, 61; doi:10.3390/vetsci5030061 www.mdpi.com/journal/vetsci
Vet. Sci.
Vet. Sci. 2018,
2018, 5,
5, 61
61 22 of
of 77
2. Case Presentation
2. Case Presentation
2.1. Cases
2.1. Cases
Case 1 involved a 3-day-old male Boxer puppy that presented at the Clinic for Obstetrics,
Case 1 involved
Gynecology a 3-day-old
and Andrology of Large male andBoxer
Smallpuppy
Animalsthatwith
presented at the Service
Ambulatory Clinic for Obstetrics,
of the Justus-
Gynecology and Andrology of Large and Small Animals with Ambulatory
Liebig University in Germany. The owner reported that the puppy was very active and continuously Service of the Justus-Liebig
UniversityNonetheless,
suckling. in Germany. he Thedid
ownernot reported
gain weight, that the
andpuppy was very
the owner active and
frequently continuously
observed suckling.
nasal discharge
Nonetheless,
after suckling.he did not gain weight, and the owner frequently observed nasal discharge after suckling.
On examination,thethe
On examination, puppy
puppy exhibited
exhibited a good a good
general general
conditioncondition
and wasand verywas very
lively. lively.
Intraoral
Intraoral examination
examination revealed CP revealed
(FigureCP (Figure
1). The 1). characterised
CP was The CP was characterised
by a midline defectby a midline
in the hard defect in
palate
the hard palate and a caudally divergent defect in the soft palate.
and a caudally divergent defect in the soft palate. The defect was moderately wide, and no The defect was moderately wide,
and no asymmetrical
asymmetrical facial growth
facial growth could be could be detected.
detected. CP was CPclassified
was classified
as “- -asH“-S- HH -S-“
H according
- -“ according to
to the
the LAHSAL
LAHSAL classification
classification [7]. [7].
No No other other congenital
congenital diseases
diseases were were detected,
detected, andand the the
puppypuppy showed
showed no
no signs of pneumonia. When milk replacer (Babydog Milk ® , Royal Canin, Köln, Germany) was
signs of pneumonia. When milk replacer (Babydog Milk® , Royal Canin, Köln, Germany) was offered,
offered,
the puppy the suckled
puppy suckled immediately.
immediately. Although Although he showed
he showed nasal nasal discharge
discharge and and occasional
occasional sneezing,
sneezing, he
he demonstrated a good appetite. He required a long time to consume the
demonstrated a good appetite. He required a long time to consume the amount of milk necessary for amount of milk necessary
for gaining
gaining body body weight.
weight. Because
Because of his of good
his good general
general condition,
condition, an attempt
an attempt at raising
at raising him himwas was
made made
and
and the puppy was assigned
the puppy was assigned to the clinic. to the clinic.
Case 22 involved
Case involvedaafemale
femaleBoxer
Boxerthat thatpresented
presented with a congenital
with a congenitalpalatal defect
palatal on the
defect onday
theof birth.
day of
The puppy was diagnosed with cleft lip and palate (CLP), or cheilognathopalatoschisis,
birth. The puppy was diagnosed with cleft lip and palate (CLP), or cheilognathopalatoschisis, which which was
classified
was as “- -asH“-
classified SH -H A L”
S Haccording
A L” according to the LAHSAL classification,
to the LAHSAL which is awhich
classification, systemisfor classifying
a system for
clefts [7]. The defect was narrow in both the hard and soft palate, measuring
classifying clefts [7]. The defect was narrow in both the hard and soft palate, measuring between between 1–2 mm in width.
1–2
No facial
mm growth
in width. Noabnormalities
facial growthwere observed. The
abnormalities were puppy showed
observed. Thea normal birth weight,
puppy showed was lively,
a normal birth
and showed no other deformities during examination.
weight, was lively, and showed no other deformities during examination.
Case 33involved
Case involved a male Collie
a male that presented
Collie with mild
that presented with bronchopneumonia,
mild bronchopneumonia, which waswhichdiagnosedwas
based on a based
diagnosed clinicalonexamination, a complete ablood
a clinical examination, count,blood
complete and an ultrasound
count, and an of the lungs.ofThis
ultrasound the puppy
lungs.
presented
This puppyatpresented
the age ofat12the days.
age The of 12puppy was puppy
days. The found to was have
founda continuous hard and soft
to have a continuous hardpalate
and
defect, classified as “- - H S H - -“ according to the LAHSAL classification [7].
soft palate defect, classified as “- - H S H - -“ according to the LAHSAL classification [7]. The defect The defect was narrow,
and narrow,
was no facialand growth abnormalities
no facial were seen. The
growth abnormalities wereowners of both
seen. The puppies
owners of bothwere willing
puppies to attempt
were willing
raising them.
to attempt raising them.
Figure 1. Cleft palate in a 3-day-old purebred male Boxer puppy (Case 1).
Figure 1. Cleft palate in a 3-day-old purebred male Boxer puppy (Case 1).
2.2. Customisation of A Palatal Prosthesis
A temporary prosthesis was crafted from a mouthguard intended for human children (Wilson
Single Density Youth Mouthguard; Wilson, Chicago, IL, USA), which is made of thermoplastic
silicone and can be reformed by heating in hot water. About 1–2 cm of the mouthguard was cut off
Vet. Sci. 2018, 5, 61 3 of 7
2.2. Customisation of A Palatal Prosthesis
A 2018,
Vet. Sci. temporary
5, 61 prosthesis was crafted from a mouthguard intended for human children 3 of 7
(Wilson Single Density Youth Mouthguard; Wilson, Chicago, IL, USA), which is made of thermoplastic
(Figure 2a)
silicone andand
canplaced in a cup
be reformed bywith boiling
heating water.
in hot After
water. a few1–2
About seconds,
cm of the material
mouthguardsoftened
wasand the
cut off
silicone2a)
(Figure could
and beplaced
reformed in afor
cupabout
with30–60 seconds.
boiling water.Thus,
Aftera plate
a fewwith a height
seconds, theof approximately
material softened 0.3and
cm
wassilicone
the prepared.
could During the crafting
be reformed procedure,
for about the mouthguard
30–60 seconds. Thus, a plate was heated
with andofsoftened
a height several
approximately
times.
0.3 cm wasAfterprepared.
hardening, the edges
During of the plate
the crafting were cut
procedure, the off until a sizewas
mouthguard matching
heated that
and of the upper
softened jaw
several
of the After
times. puppy was obtained
hardening, (Figure
the edges 2b).plate
of the When the cut
were optimal sizea and
off until size thickness
matching that(approximately
of the upper4jaw cm
long,
of the 2puppy
cm wide,
was 0.3 cm thick)
obtained were
(Figure achieved,
2b). When the theoptimal
siliconesize
plate
andwas pressed(approximately
thickness against the upper4 cmjawlong,of
2the
cmpuppy
wide, 0.3(Figure 2c) towere
cm thick) produce a prosthesis
achieved, the siliconethatplate
was was
adjusted
pressedto against
the maxilla (Figure
the upper jaw2d). No
of the
anaesthesia
puppy (Figurewas2c) required
to produce during this procedure.
a prosthesis The prosthesis
that was adjusted was only
to the maxilla inserted
(Figure 2d). Noinanaesthesia
the mouth
during
was bottle during
required feedingthisandprocedure.
did not require fixation. The
The prosthesis was puppies tolerated
only inserted themouth
in the prosthesis
duringwell and
bottle
showed and
feeding rapiddidandnotnormal
requiremilk intake.The
fixation. Although
puppies small amounts
tolerated theofprosthesis
nasal discharge
well andwere occasionally
showed rapid
observed
and normal after
milk drinking,
intake. sneezing
Althoughand coughing
small amounts were neverdischarge
of nasal observed,were and there were noobserved
occasionally signs of
aspiration.
after drinking,After 2 weeks,
sneezing anda coughing
new prosthesis had toobserved,
were never be customised,
and thereas described
were no signsabove, because of
of aspiration.
physiological
After 2 weeks, growth of the puppy.
a new prosthesis had toAtbe6 customised,
weeks of age, as the ownersabove,
described beganbecause
mixing of thephysiological
puppy milk
(Babydog
growth Milk®
of the , Royal
puppy. At Canin,
6 weeksKöln, Germany)
of age, the owners withbegan
wet dog
mixingfoodthe(Starter
puppyMousse® , Royal Milk
milk (Babydog Canin, ®,
Köln, Germany),
Royal Canin, Köln, and at 2.5 months
Germany) withofwetage,
dogthey changed
food theMousse
(Starter ®
feed to commercial
, Royal Canin, dry Köln,
dog food (Puppy
Germany),
Large
and Breed®
at 2.5 months, Eukanuba,
of age, they Coevorden,
changed the Netherlands), which the
feed to commercial dry puppies
dog foodcould(Puppy eatLarge
without
Breedthe ®,
prosthesis.Coevorden,
Eukanuba, The puppies showed no difficulty
Netherlands), which theinpuppies
drinking water.
could eat without the prosthesis. The puppies
showed no difficulty in drinking water.
Figure 2.2. A
Figure A small
small portion
portion ofof the
the Wilson
Wilson Single
Single Density
Density Youth
Youth Mouthguard
Mouthguard (Wilson
(Wilson Single
Single Density
Density
Youth
YouthMouthguard,
Mouthguard, Wilson,
Wilson,Chicago,
Chicago, IL,
IL,USA)
USA) isis cut
cutoff
off(a).
(a). A
A plate
plate matching
matching the
the size
size of
of the
the upper
upper
jaw is crafted by repeated heating, softening, and reforming the thermoplastic silicone
jaw is crafted by repeated heating, softening, and reforming the thermoplastic silicone (b). The warm (b). The warm
silicone
silicone plate
plate is
is pressed
pressed against
against the
the upper
upper jawjawofofthethepuppy
puppy(c).(c). The
Thecustomised
customised temporary
temporary palatal
palatal
prosthesis
prosthesisprepared
preparedfor forpuppies
puppies with
with cleft
cleft palate
palate from
from the
the Wilson
Wilson Single
Single Density
Density Youth
Youth Mouthguard
Mouthguard
for
for human
human children
children(d).
(d).
2.3. Further Therapies
All puppies were treated with frequent inhalation of ambroxol during the first 2 weeks
(Mucosolvan® , 6 mg per inhalation, Boehringer Ingelheim, Ingelheim am Rhein) to clear the upper
respiratory tract. The puppy in Case 3 received amoxicillin–clavulanic acid for 10 days (Synulox® ,
12.5 mg/kg body weight, orally, twice a day, Zoetis, Berlin, Germany) for the management of
bronchopneumonia.
Vet. Sci. 2018, 5, 61 4 of 7
2.3. Further Therapies
All puppies were treated with frequent inhalation of ambroxol during the first 2 weeks
(Mucosolvan® , 6 mg per inhalation, Boehringer Ingelheim, Ingelheim am Rhein) to clear the
upper respiratory tract. The puppy in Case 3 received amoxicillin–clavulanic acid for 10 days
Vet. Sci. 2018, 5, 61 4 of 7
(Synulox® , 12.5 mg/kg body weight, orally, twice a day, Zoetis, Berlin, Germany) for the management
of bronchopneumonia.
2.4. Development
2.4. Development
The puppy in Case 1 was raised by one of the authors in isolation from its littermates, while the
otherThe
twopuppy
puppies in were
Case raised
1 was along
raisedwith
by onetheir
oflittermates
the authorsbyintheir respective
isolation from owners. Both ofwhile
its littermates, them
the other two puppies were raised along with their littermates by their respective owners. BothAll
suckled from their mothers without the prosthesis; however, there was no effective milk intake. of
puppies were fed by bottle with the prosthesis in place. The puppy in Case 2 showed
them suckled from their mothers without the prosthesis; however, there was no effective milk intake. signs of
pneumonia at approximately 6 weeks of age, but recovered and developed well after
All puppies were fed by bottle with the prosthesis in place. The puppy in Case 2 showed signs of the treatment
with amoxicillin–clavulanic
pneumonia at approximatelyacid (Synulox®
6 weeks of age,, but
12.5recovered
mg/kg bodyandweight,
developedorally,
welltwice
after athe
day, Zoetis,
treatment
Berlin, Germany). Although the puppies ®showed good food intake, the two Boxer puppies
with amoxicillin–clavulanic acid (Synulox , 12.5 mg/kg body weight, orally, twice a day, Zoetis, Berlin, exhibited
slower body
Germany). weight gain
Although than their
the puppies littermates,
showed while
good food the Collie
intake, the twodeveloped at the exhibited
Boxer puppies same rateslower
as his
littermates.
body weight gain than their littermates, while the Collie developed at the same rate as his littermates.
2.5. Outcomes
2.5. Outcomes and
and Follow-up
Follow-up
Between 5–6
Between 5–6 months
months ofofage,age,allall
three
threepuppies
puppies(Figure 3) underwent
(Figure 3) underwent corrective surgery.
corrective Pre-
surgery.
operatively, a complete blood count and a blood chemistry test were performed
Pre-operatively, a complete blood count and a blood chemistry test were performed on all dogs. on all dogs. All
values
All were
values within
were withinnormal
normal range.
range.ForForcorrective
correctivesurgery,
surgery,thethe medially double-flap
medially repositioned double-flap
technique (von
technique (von Langenbeck
Langenbeck technique) was used for the the hard
hard palate
palate [8][8] and
and the
the double-layer
double-layer
appositional technique
appositional technique was usedused forfor the
the soft
soft palate.
palate. The
The surgical
surgical wounds
wounds healed
healed well,
well, with
with normal
normal
symmetry between
symmetry between thethe right
right and
and left
left sides
sides of
of the
the maxilla
maxilla (Figure
(Figure 4).
4). The
The puppy
puppy in in Case
Case 11 developed
developed
mandibular
mandibular mesioclusion after surgery. The cleft lip wound in the puppy in
surgery. The cleft lip wound the puppy in Case 2 opened upCase 2 opened up after
after
surgery, but
surgery, but the
the owner
owner decided
decided against
against further
further corrective
corrective surgery
surgery because
because there
there was
was no
no functional
functional
constraint. All puppies achieved the same body size and weight
constraint. weight as as their
their littermates.
littermates. At the time
time of
of
writing this article, the dogs were aged 2–4 years. All dogs were healthy and
writing this article, the dogs were aged 2–4 years. All dogs were healthy and showed no problems showed no problems
associated with
associated with their
their congenital
congenitaldefects
defects(Figure
(Figure5). 5).The
Thecleft liplip
cleft persisted
persistedin the puppy
in the puppyin Case 2, but
in Case 2,
thisthis
but represents a cosmetic
represents defect
a cosmetic only.
defect only.
Figure 3. Cleft
Figure 3. Cleft palate/cleft lip and
palate/cleft lip and palate
palate on
on the
the day
day of
of corrective
corrective surgery
surgery in
in Case
Case 11 (a),
(a), Case
Case 22 (b)
(b) and
and
Case 3 (c).
Case 3 (c).
Vet. Sci. 2018, 5, 61 5 of 7
Vet. Sci. 2018, 5, 61 5 of 7
Vet. Sci. 2018, 5, 61 5 of 7
Figure
Figure
Figure4.4. Intraoral
4. Intraoral images
Intraoral images of
images of Case
Case 222 (a)
of Case (a) and
(a) and Case
Case 333 (b)
and Case (b)
(b) 333 days
days after
days after surgery,
after surgery, and
surgery,and Case
Case111(c)
andCase (c)
(c)222months
months
months
after
after surgery.
aftersurgery. Cases
surgery.Cases 2 and
Cases22and 3 did
and33did not
didnot require
notrequire any
requireany further
anyfurther surgery.
furthersurgery. Case
surgery.Case 1 still
Case11still showed
stillshowed some
showedsome fistulas
fistulas222
somefistulas
months
months after
monthsafter surgery,
aftersurgery, which
surgery,which were
whichwere successfully
weresuccessfully closed.
successfullyclosed.
closed.
Figure
Figure5.5.
Figure Intraoral
5.Intraoral images
Intraoralimages of
imagesof Case
Case111(a)
ofCase (a)
(a)444years
years and
years and Case
Case 222 (b)
and Case (b) and
and Case
Case 33 (c)
(c) 22 years
yearsafter
years aftersurgery.
after surgery.
surgery.
3. Discussion
3. Discussion
3. Discussion
Although
Although CP
Although CP
CP isis one
isone
oneofof the
ofthe most
themost common
mostcommon congenital
commoncongenital craniofacial
congenitalcraniofacial defects
craniofacial defects
defects inin dogs,
indogs,
dogs,mostmost puppies
mostpuppies
puppies
are euthanised
are euthanised
are euthanised or or die
ordie because
diebecause
becauseof of aspiration
ofaspiration pneumonia.
aspirationpneumonia. Corrective
pneumonia. Corrective surgery
Corrective surgery
surgery cancan
can be be performed
be performed
performed at at an
at an
an
age of
age of
age about
of about 4–6
about 4–6 months
4–6 months
months [5].[5]. Until
[5]. Until the
Until the puppy
the puppy is old enough
puppy is old enough for surgery,
enough for surgery, nutrition
surgery, nutrition
nutrition has has to
has to be
to be ensured,
be ensured,
ensured,
and
andthe
and the risk
therisk
risk of
of aspiration
aspiration
of aspiration pneumonia
pneumonia
pneumonia has tohas
has to
to bebe minimised.
be minimised. minimised. In
In children,
In children, a feedingaaobturator
children, feeding
feeding isobturator
obturator
commonly is
is
commonly
commonly provided
provided until
until corrective
corrective surgery
surgery is
is performed
performed [9,10].
[9,10]. The
The preparation
preparation
provided until corrective surgery is performed [9,10]. The preparation of prosthodontic obturators after of
of prosthodontic
prosthodontic
obturators
corrective after
after corrective
obturatorssurgery corrective surgery
surgery
for congenital as for
wellcongenital
for congenital
as acquired as well
as cleft as
as acquired
well palates
acquired cleft palates
cleftand
in dogs palates in
in dogs
cats has beenand
dogs and cats
cats has
has
previously
been previously
been previously
described [2,11,12].described
described [2,11,12].
[2,11,12].
Martinez-Sanz Martinez-Sanz
Martinez-Sanz
et al. [4] described et et al. [4] described
theal.preparation
[4] described the preparation
the preparation
of customised of
feeding customised
of customised
teats using
afeeding
feeding teats
teats using
using aa thermovacuum-forming
thermovacuum-forming thermovacuum-forming
machine under anaesthesia machine
machine under
under
for the anaesthesia
anaesthesia
management andfor the
the management
forraising management
of puppies with and
and
raising
raising of puppies
of surgery. with
puppies Although CP before
with CP before surgery. Although
surgery. Although they
they described
described an effective way to raise puppies
CP before they described an effective way to raise an effective
puppies with wayCP,tothe
raise puppies
procedure
with
with
for CP,
CP, the
the procedure
manufacturing procedure for manufacturing
forand
the teats manufacturing the
the teats
palatal prosthesis teats and
and palatal
is complex and prosthesis
palatal prosthesis is
is complex
requires special complex and
and requires
equipment requires
as well
special
special equipment as well as anaesthesia. In the cases presented here, the preparation procedure for
equipment as well as anaesthesia. In the cases presented here, the preparation procedure for
the
the palatal
palatal prosthesis
prosthesis was was inexpensive,
inexpensive, simple,
simple, andand effective;
effective; moreover,
moreover, no no anaesthesia
anaesthesia was was needed,
needed,
all
all of
of which
which areare important
important factors
factors in
in the
the willingness
willingness of of owners
owners to to raise
raise aa puppy
puppy withwith CP.
CP. Although
Although aaVet. Sci. 2018, 5, 61 6 of 7
as anaesthesia. In the cases presented here, the preparation procedure for the palatal prosthesis was
inexpensive, simple, and effective; moreover, no anaesthesia was needed, all of which are important
factors in the willingness of owners to raise a puppy with CP. Although a palatal prosthesis needs to
be prepared several times as the puppy grows, only one mouthguard (Wilson Single Density Youth
Mouthguard) could supply all the material necessary for all the prostheses. Furthermore, the owners
could replicate the manufacturing procedure after observing it once, although regular supervision
by a veterinarian is recommended. This approach allows the puppy to grow up in a normal social
environment. This approach also makes bottle feeding and suckling possible (which are important
for normal craniofacial growth [13]) with minimal risk of milk aspiration and subsequent pneumonia.
This prosthesis allows for the normal raising of such puppies until most of the maxillofacial growth is
complete, preventing maxillofacial deformities and inhibiting maxillary growth that can occur because
of palatoplastics [8,14,15]. Although the puppy in Case 1 developed mandibular mesioclusion after
surgery, this can be attributed to the breed and was not considered a consequence of the surgery.
The optimal time and technique for surgery should be chosen according to the size of the cleft
palate [7,16–19]. Although there are various reasons for the development of congenital palatoschisis,
there is a genetic predisposition [20–22], and castration of the animal is strongly advised.
4. Conclusions
In summary, we described the successful management of puppies with CP using a temporary
customised prosthesis, which allowed them to be bottle-fed and successfully raised until corrective
surgery could be performed. The findings from this report show that a puppy with CP can be raised
with little effort and at low cost, thus encouraging owners to seek appropriate treatment for such
puppies instead of considering euthanasia.
Author Contributions: T.C. conceived the idea for manufacturing the prosthesis, customised it for the three
puppies, and raised the puppy in Case 1; I.R. performed the corrective surgery for all puppies and contributed
with her broad knowledge of stomatology; and R.H. and A.W. supported and financed the project. All authors
have reviewed the article and approved it for final submission.
Funding: This research received no external funding.
Acknowledgments: We thank Daniela Graulich for the help with all the cleft palate puppies.
Conflicts of Interest: The authors declare no conflicts of interest.
References
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Hoskins, J.D., Ed.; W.B. Saunders: Philadelphia, PA, USA, 1995; p. 73, ISBN 0721638872.
2. Lee, J.I.; Kim, Y.S.; Kim, M.J.; Lee, J.; Choi, J.H.; Yeom, D.B.; Park, J.M.; Hong, S.H. Application of a temporary
palatal prosthesis in a puppy suffering from cleft palate. J. Vet. Sci. 2006, 7, 93–95. [CrossRef] [PubMed]
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