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Kumar V, Firdaws H, Fernandes S. Nasoalveolar Molding Therapy in a Newborn With Cleft Lip and Palate: A Case Report. Cureus 2024; 16:e69425. [PMID: 39411611 PMCID: PMC11473672 DOI: 10.7759/cureus.69425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/19/2024] Open
Abstract
Cleft lip and palate are common congenital deformities that significantly impact facial anatomy and function, often requiring surgical intervention to correct. Presurgical nasoalveolar molding (NAM) therapy has emerged as an effective nonsurgical approach to improve surgical outcomes by reducing the severity of clefts and molding the alveolar, lip, and nasal segments into more favorable positions. This case report describes the use of NAM therapy in a 15-day-old patient with unilateral cleft lip, palate, and nasal involvement to improve outcomes before cheiloplasty. The patient presented with significant feeding difficulties due to a large palatal cleft. After obtaining parental consent, we conducted a series of procedures to construct and insert an acrylic NAM plate with a retention button and nasal stent, performing weekly adjustments to reshape the alveolar segments and nasal cartilage. Weekly remodeling included selective modifications to the NAM plate, the addition of soft liners, and the use of nasal stents to lift the collapsed nasal cartilages and restore nasal symmetry. Post-treatment results showed a substantial reduction in the cleft lip gap from 17 mm to 6 mm, alveolus gap from 14 mm to 4 mm, left nasal width from 17 mm to 11 mm, and increased left alar height from 4 mm to 7 mm. The successful application of NAM therapy demonstrated its effectiveness in reducing cleft gaps, improving nasal anatomy, and preparing the patient for future surgical interventions with minimal scar formation. This case reinforces the benefits of NAM in reducing cleft deformities, improving feeding function, and avoiding more invasive surgical procedures.
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Affiliation(s)
- Vinod Kumar
- Pediatric Dentistry, Navodaya Dental College and Hospital, Raichur, IND
| | - Hibah Firdaws
- Pediatric Dentistry, Navodaya Dental College and Hospital, Raichur, IND
| | - Shobha Fernandes
- Pediatric Dentistry, Narsinhbhai Patel Dental College and Hospital, Visnagar, IND
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Mossaad AM, Abdelrahman MA, Waly SA, Sapri AM, Ghanem W, Elsayed SAN. Using an Active Screwed Nasoalveolar Molding Device for Defect Rehabilitation in Patients With Bilateral Cleft Lip and Palate. Cureus 2024; 16:e68204. [PMID: 39347357 PMCID: PMC11439370 DOI: 10.7759/cureus.68204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
The present case series aimed to assess non-surgical elongation of the columella and reduction of cleft gaps in patients with bilateral cleft lip and palate using the active nasoalveolar molding (ANAM) device and tissue expansion principles. The study included six complete bilateral cleft patients aged one month: three males and three females. A nasoalveolar molding technique was applied using an active device (ANAM) with a 3D screw, worn by infants for two months. The activation protocol for screw closure is approximately 0.25 mm (quarter turn) on alternating days, resulting in almost 1 mm per week and 4 mm per month and reaching 8 mm after eight weeks. Evaluation involved measuring lip defect sizes and the nostril gap, columellar length and rotation of premaxilla before and two months after the ANAM period before surgical repair. The results show that the anterior rotation of the premaxilla and the lip and nostril gaps were significantly reduced (p < 0.05), with maximum reduction in the anterior rotation of the premaxilla (mean difference ± SD was 4.22 ± 0.4). Simultaneously, the columellar height was significantly increased with a mean difference ± SD of 2.0 ± 0.4 (p < 0.001). The current case series demonstrated that the ANAM device is a safe and effective technique for decreasing the lip and nostril gaps, repositioning the protruded premaxilla, and elevating the depressed columella. No side effects were recorded in current cases.
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Affiliation(s)
| | | | - Salem A Waly
- Oral and Maxillofacial Surgery, Al-Azhar University, Cairo, EGY
| | - Ahmed M Sapri
- Oral and Maxillofacial Surgery, Mansoura University, Mansoura, EGY
| | - Wael Ghanem
- Pediatric Plastic Surgery, Ain Shams University, Cairo, EGY
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Jaiswal A, Galhotra V, Angel L S, Gandham R. Pre-surgical Nasal Molding of a Two-Day-Old Neonate With Complete Unilateral Cleft Lip and Palate Using Passive Nasoalveolar Molding Technique: A Case Report. Cureus 2024; 16:e51822. [PMID: 38327955 PMCID: PMC10847393 DOI: 10.7759/cureus.51822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
The occurrence of congenital deformities like cleft lip and palate is not uncommon and is often a traumatizing experience for families. The entire rehabilitation process includes frequent hospital visits and the brunt of numerous procedures. Early intervention with pre-surgical infant orthopedics facilitates better surgical outcomes and additional psychosocial benefits to the infant's family. The present clinical report addresses the pre-surgical management of a non-syndromic two-day-old female baby whose parents presented with the chief complaint of deformed lips, nose, and difficulty while feeding. The neonate had a complete left-sided cleft lip, alveolus, and cleft palate on examination. Early management with pre-surgical passive nasoalveolar molding (PNAM) has favorable outcomes, including desired upper lip, alveolus, and nose shape. Non-invasive pre-surgical intervention with PNAM reduces the severity of the deformities before the primary surgical repair, thus decreasing the overall cost of cleft care and the number of secondary revisions, thus increasing the probability of favorable outcomes.
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Affiliation(s)
- Abhijeet Jaiswal
- Orthodontics and Dentofacial Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
| | - Virat Galhotra
- Pediatric Dentistry, All India Institute of Medical Sciences, Raipur, IND
| | - Saraa Angel L
- Orthodontics and Dentofacial Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Rhea Gandham
- Pediatric Dentistry, All India Institute of Medical Sciences, Raipur, IND
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The Effectiveness of Preoperative Correction Techniques in Improving Nasal Deformity in Children With Unilateral Complete Cleft Lip and Palate. J Craniofac Surg 2021; 32:664-669. [PMID: 33705005 DOI: 10.1097/scs.0000000000007145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Unilateral complete cleft lip and palate (UCCLP) is associated with apparent nasal deformities before the cheilorrhaphy. The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral UCCLP used by the systematic review and meta-analysis. METHODS We searched Medline, Cochrane Library, EMBASE, PubMed, and Chinese BioMedical Literature Database (CBM) until January 31, 2019, to identify studies that compared the effectiveness of preoperative correction techniques in the treatment of nasal deformities in infant with UCCLP. Two authors individually extracted the data and performed the quality assessments. The height of nasal columella, the width of the affected side nasal ala and the inclination of the nasal columella were evaluated. RESULTS Seven articles were incorporated into the systematic review, and 5 (274 participants) in the meta-analysis according to the inclusion criteria. The preoperative correction could increase the height of nasal columella in children with UCCLP [SMD: 2.64 mm; 95% confidence intervals (CI); (1.35 mm, 3.94 mm); P < 0.0001]. Moreover, the preoperative correction resulted in reduced width of the affected side nasal ala [SMD: -5.14 mm; 95% CI; (-8.96 mm, -1.31 mm); P = 0.008]; However, the evidence was insufficient to determine a significant effect on the inclination of the nasal columella [SMD: -3.48 degrees; 95% CI; (-7.56 degrees, 0.59 degrees); P = 0.09]. CONCLUSIONS Preoperative correction for children with UCCLP can increase the height of nasal columella, reduce the width of the affected side nasal ala, improve the nasal symmetry, and reduce nasal deformity, however, no significant effect could be observed for the inclination of the nasal columella.
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Padovano WM, Skolnick GB, Naidoo SD, Snyder-Warwick AK, Patel KB. Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2021; 59:462-474. [PMID: 33882703 DOI: 10.1177/10556656211009702] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to investigate long-term treatment effects of nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate (UCLP). DESIGN Included manuscripts met the following criteria: (1) involved patients with UCLP who received NAM; (2) included comparison group(s) who either received non-NAM passive presurgical infant orthopedic appliances (PSIO) or who did not receive any PSIO; (3) reported at least one objective or validated measure of nasolabial, craniofacial, or palatal form; and (4) had patient follow-up beyond 4 years of age. RESULTS A total of 12 studies were included in this review. Meta-analyses were possible for Asher-McDade parameters and cephalometric measurements. Compared to patients who did not receive any PSIO, those who underwent NAM therapy were more likely to have good to excellent frontal nasal form (Risk ratio: 2.4, 95% CI: 1.24-3.68) and vermillion border (Risk ratio: 1.8, 95% CI: 1.19-2.71). However, there were no statistically significant differences in cephalometric measurements between these groups. Additionally, there were no statistically significant differences between patients receiving NAM versus non-NAM PSIO. There was insufficient evidence to determine the impact of NAM on dental arch development. CONCLUSIONS The preponderance of evidence in this review suggests that NAM produces benefits in nasolabial aesthetic form when compared with no appliance-based presurgical treatment. However, there is insufficient evidence to conclude whether NAM produces such benefits when compared with other passive PSIOs.
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Affiliation(s)
- William M Padovano
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
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Leberfinger AN, Jones CM, Mackay DR, Samson TD, Henry CR, Ravnic DJ. Computer-Aided Design and Manufacture of Intraoral Splints: A Potential Role in Cleft Care. J Surg Res 2021; 261:173-178. [PMID: 33444946 DOI: 10.1016/j.jss.2020.11.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasoalveolar molding is a nonsurgical modality for the treatment of cleft lip and palate that uses an intraoral splint to align the palatal shelves. Repeated impressions are needed for splint modification, each carrying risk of airway obstruction. Computer-aided design and manufacturing (CAD/CAM) has the ability to simplify the process. As a precursor to CAD/CAM splint fabrication, a proof-of-concept study was conducted to compare three-dimensional splints printed from alginate impressions versus digital scans. We hypothesized that intraoral digital scanning would compare favorably to alginate impressions for palate registration and subsequent splint manufacture, with decreased production times. METHODS Alginate and digital impressions were taken from 25 healthy teenage volunteers. Digital impressions were performed with a commercially available intraoral scanner. Plaster casts made from alginate impressions were converted to Standard Triangle Language files. Patient-specific matched scans were evaluated for total surface area with the concordance correlation coefficient. Acrylic palatal splints were three-dimensionally printed from inverse digital molds. Subjective appliance fit was assessed using a five-point scale. RESULTS A total of 23 participants were included. Most subjects preferred digital impression acquisition. Impression methods showed moderate agreement (concordance correlation coefficient 0.93). Subjects rated splints from digital impressions as having a more precise fit (4.4 versus 3.9). The digital approach decreased impression phase time by over 10-fold and overall production time by 28%. CONCLUSIONS CAD/CAM has evolved extensively over the past two decades and is now commonplace in medicine. However, its utility in cleft patients has not been fully realized. This pilot study demonstrated that CAD/CAM technologies may prove useful in patients requiring intraoral splints.
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Affiliation(s)
- Ashley N Leberfinger
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Christine M Jones
- Division of Plastic Surgery, Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Donald R Mackay
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Thomas D Samson
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cathy R Henry
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Dino J Ravnic
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip. J Oral Maxillofac Surg 2018; 76:2612-2617. [PMID: 29864433 DOI: 10.1016/j.joms.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images. PATIENTS AND METHODS Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non-normally distributed data. RESULTS Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH-to-normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups. CONCLUSIONS Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.
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Subcutaneous C Shape Muscular Flap for Correcting the Depression of Alar Base in Affected Side in Patients With Unilateral Complete Cleft Lip/Palate During Primary Surgery. J Craniofac Surg 2018; 28:1078-1080. [PMID: 28230602 DOI: 10.1097/scs.0000000000003623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The depression of alar base in affected side in patients with unilateral complete cleft lip/palate (CL/P) is one of common clinical features. In this study, the authors try to explore the effect of subcutaneous C shape muscular flap for correcting the depression of alar base in affected side in patients with unilateral complete CL/P during primary surgery. METHODS A total of 30 patients with unilateral complete CL/P who received primary correction of the lip nose deformity were included in this study. The C flap was used to drop and lengthen the height of upper lip in unaffected side, and the subcutaneous muscular flap was dissected from the C flap and positioned at the alar base in the affected side of upper lip to correct the depression. Then the surgical effect was evaluated based on clinical examination during follow-up. RESULTS Alar base symmetry was obtained in 26 patients of this case series, and 4 patients showed slight improvement in alar base symmetry. No major complications such as flap necrosis, infection, or hypertrophic scars were observed during surgery and follow-up. No additional incisions and operative time were necessary. CONCLUSION The subcutaneous C shape muscular flap described in this article could offer enough muscular support and markedly correct the depression of nostril and alar base in affected side in primary lip nose repair with no additional incisions and operative time for patients with unilateral complete CL/P.
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Abstract
INTRODUCTION Unilateral cleft lip (UCL) patients have lip and nose deformities that must be addressed during lip repair. Currently, devices to achieve lip and nose improvements have been developed. The most researched presurgical molding device is the nasoalveolar molding (NAM), which has shown favorable results. However, clinical observation shows that unilateral cleft patients, even without molding devices, achieve spontaneous improvements. The aim of this study is to compare morphological and symmetry changes in nose and lip, between patients less than 30-day old and those submitted to cheiloplasty, at 6 months of age. MATERIALS AND METHODS A total of 27 UCL patients with 2 photographs were selected. The pictures were taken from frontal view and nasal base view at 2 distinct moments: before 30 days of life (t1) and at 6 months of age, during cheiloplasty surgery (T2). Images were analyzed with indirect measurement to assess lip and nose dimensions and nasal symmetry. ImageJ software was used to perform the analyses. RESULTS A total of 20 patients (P < 0.05) had an average cleft width reduction of 15% [standard deviation (SD) ± 11%]. A 55% average increase (SD ± 29%) was observed in nostril height of cleft side in 16 of patients (P < 0.05). There was an reduction in facial asymmetry of nostril width (P < 0.05), from 95% (SD ± 90%) (t1) to 59% (SD ± 50) (T2). Also, nasal base width asymmetry (P < 0.05) was decreased from 64% (SD ± 66%) (t1) to 40% (SD ± 29%) (T2). CONCLUSION Facial growth causes a natural improvement on cleft morphological changes and nasal symmetry.
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Patil PG, Nimbalkar-Patil SP. Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate. J Prosthodont 2016; 27:94-97. [PMID: 27002917 DOI: 10.1111/jopr.12464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 11/29/2022] Open
Abstract
Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.
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Affiliation(s)
- Pravinkumar G Patil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Jayashree M, Paul S. Naso alveolar molding in early management of cleft lip and palate. J Indian Prosthodont Soc 2014; 13:362-5. [PMID: 24431761 DOI: 10.1007/s13191-012-0171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 08/19/2012] [Indexed: 11/28/2022] Open
Abstract
Cleft lip and palate is a congenital anomaly occurring at birth. This article describes about the construction of feeding plate which is also used for naso alveolar molding (NAM). The main objective of this treatment is that this procedure minimizes the extent of surgery that should be done on newborns. Two infants with unilateral and bilateral cleft lip and palate are treated by making feeding plate and which is also used for NAM. Both the infants had favorable results, better in case of unilateral cleft lip patient; we hope that it will minimize the extent of surgery and the resultant scarring.
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Affiliation(s)
- Mohan Jayashree
- Department of Prosthetic Dentistry, Vinayaka Mission's Dental College, Salem, Tamilnadu India ; Salem Polyclinic, 128, Omalur Road, Salem, 636007 India
| | - Simon Paul
- Department of Prosthetic Dentistry, Vinayaka Mission's Dental College, Salem, Tamilnadu India
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Kamble VD, Parkhedkar RD, Sarin SP, Patil PG, Kothari B. Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: a clinical report. J Prosthodont Res 2013; 57:224-31. [PMID: 23773376 DOI: 10.1016/j.jpor.2013.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/10/2013] [Accepted: 03/06/2013] [Indexed: 11/29/2022]
Abstract
PATIENT A 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention. DISCUSSION The alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate. CONCLUSION As a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.
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Affiliation(s)
- Vaibhav D Kamble
- Department of Prosthodontics, VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India.
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Chammanam SG, Biswas PP, Kalliath R, Chiramel S. Nasoalveolar moulding for children with unilateral cleft lip and palate. J Maxillofac Oral Surg 2013; 13:87-91. [PMID: 24821996 DOI: 10.1007/s12663-013-0490-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 02/19/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cleft lip and palate represents the most frequently occurring congenital deformity second only to club foot deformity in our country. Wide alveolar clefts if not preceded by pre surgical orthodontic adjuncts like nasoalveolar moulding, may affect the final outcome of the primary surgery. Presurgical nasoalveolar moulding is to align and approximate the alveolar cleft segments while at the same time achieving correction of the nasal cartilage and soft tissue deformity. MATERIALS AND METHODS The device we used is designed by Barry Grayson. It is simple to fabricate, causes less discomfort to the patient and optimum results are achieved in three months of time, compared to other complicated appliances like Latham's which are more invasive. A child of 3 months presented with a complaint of unilateral cleft deformity on one side of the face. CONCLUSION After three months of nasoalveolar moulding considerable changes were observed. The widths of the cleft alveolus were reduced and the nasal contours of columella on the cleft side showed considerable improvement.
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Affiliation(s)
- Shaju George Chammanam
- Department of Oral and Maxillofacial Surgery, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala India
| | - P P Biswas
- Department of Orthodontics, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala India
| | - Ranjith Kalliath
- Department of Oral and Maxillofacial Surgery, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala India
| | - Siji Chiramel
- Department of Oral and Maxillofacial Surgery, Royal Dental College, Iron Hills, Chalissery, Palakkad, Kerala India
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Presurgical orthopaedic nasoalveolar molding in cleft lip and palate infants: a comparative evaluation of cases done with and without nasal stents. J Maxillofac Oral Surg 2012; 12:273-88. [PMID: 24431854 DOI: 10.1007/s12663-012-0434-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022] Open
Abstract
Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.
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Patil PG, Patil SP, Sarin S. Nasoalveolar molding with active columellar lengthening in severe bilateral cleft lip/palate: a clinical report. J Prosthodont 2012; 22:137-42. [PMID: 22946934 DOI: 10.1111/j.1532-849x.2012.00909.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Severe bilateral cleft-lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5-day-old male infant with bilateral cleft-lip-palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft-lip/palate cases, simple modifications in the appliance can achieve rapid results.
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Affiliation(s)
- Pravinkumar G Patil
- Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India.
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Patil PG, Patil SP, Sarin S. Nasoalveolar molding and long-term postsurgical esthetics for unilateral cleft lip/palate: 5-year follow-up. J Prosthodont 2012; 20:577-82. [PMID: 22003833 DOI: 10.1111/j.1532-849x.2011.00782.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The nasoalveolar molding (NAM) technique has been shown to significantly improve the surgical outcome of the primary repair in cleft lip and palate patients. A 6-day-old female infant was managed with the presurgical NAM technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the next 5 months. The 13 mm of alveolar cleft width was reduced to 1.5 mm. The depressed nostril on the cleft side was molded into the normal anatomy. The nose and upper lip were surgically repaired at the age of 5 months. The second stage surgery of palatal closure was performed at the age of 18 months. The patient was followed up regularly at 6-month intervals for the next 5 years.
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Affiliation(s)
- Pravinkumar G Patil
- Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India.
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A Novel Technique for Presurgical Nasoalveolar Molding Using Computer-Aided Reverse Engineering and Rapid Prototyping. J Craniofac Surg 2011; 22:142-6. [DOI: 10.1097/scs.0b013e3181f6f9ae] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Design features and simple methods of incorporating nasal stents in presurgical nasoalveolar molding appliances. J Craniofac Surg 2010; 20 Suppl 2:1889-94. [PMID: 19816371 DOI: 10.1097/scs.0b013e3181b6c74a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Presurgical nasoalveolar molding (NAM) in the orofacial orthopedic treatment of unilateral clefts of the lip and palate aims to align and approximate the maxillary hemialveolar segments and simultaneously support and mold the deformed nasal cartilages, correct and center nasal tip projection, and lengthen the deficient cleft-side columella in early infancy, before the primary reparative lip surgery. A number of techniques of achieving these objectives have been described in the literature and are increasingly being practiced by cleft care teams around the world. However, a detailed description of the nasal stent is lacking in the literature and needs to be elucidated to facilitate greater usage of presurgical NAM in contemporary practice. This report fills this void by providing an analytical description of the different parts of the nasal stent; clarifies their desirable design features, anatomic correlations, and clinical importance; and illustrates in a step-by-step manner simple direct and indirect methods of incorporating a nasal stent, improvised by the author in his practice, that can be used with any of the contemporary NAM appliances and techniques. From the simple methods described, clinicians will be enabled to select one that may be most easily adaptable to their preferred appliance and clinical setting.
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