A New Approach to Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate and Severe Cleft Width

Nasoalveolar Molding in Lately Presented Moderate to Severe Unilateral Cleft Lip and Palate Infants: Does it Add?

Alignment of the alveolar segments with early nasal cartilage tackling is the foundation upon which excellent surgical results are dependent. The purpose is to evaluate the short-term effect of triple combination of passive alveolar molding with early nasal molding augmented by controlled corrective power of lip tapping in lately presented moderate to severe unilateral complete cleft lip and palate infants. A prospective case series study was conducted in Plastic and Maxillofacial Surgery Department, Ain Shams University in collaboration with Orthodontics Department, from January 2021 till June 2023, 15 infants elder than 2 months till 6 months were enrolled in the study. Eight nasal anthropometric measurements ratios through 2-dimension assessment and 4 maxillary arch measurements ratios through 3-dimension assessment were recorded. Extraoral results revealed clinically and statistically decrease of nasal width, alar base width, alar base height ratios, and columellar angle, while increase of nasal height, nasal dome height, columellar length, and alar projection length ratios. Intraoral results revealed clinically and statistically decrease in cleft width with maintained posterior arch width and intercanine width. In conclusion, this triple combination helped in presurgical lessening the alveolar and nasal deformity of such elder infants in a shorter time in comparison with other conventional methods with lesser number of appointments decreasing burden of care to their families improving their compliance.

Primary Nasal Correction in Unilateral Cleft Lip: An Ongoing Journey

BACKGROUND

A cleft lip deformity, whether unilateral or bilateral, is usually associated with a deformity of the nose. In present day cleft surgery, it is routine to perform a varying extent of correction of the nasal deformity. There is often relapse and ongoing deformity which warrant further nasal surgery. The authors describe their method of nasal correction which includes using a hypodermic needle to help achieve repositioning and suspension of the nasal cartilages.

MATERIALS AND METHOD

The authors reviewed 100 consecutive cases of unilateral cleft lip who had nasal correction since June 2018. There were 59 males and 41 females with a mean age of 5.5 months. There were 72 complete and 28 incomplete cleft lips. The steps in nasal correction include septal repositioning, sutures to approximate the ala domes, and upper medial crura, suspension of the lower lateral cartilage to the upper lateral cartilage and sutures to approximate the skin, lower lateral cartilage, and mucosa in a sandwich fashion.

RESULTS

The patients were followed up for a range of 9 to 21 months with a mean of 18 months. The correction immediately postop and at 2 weeks follow up was good. However, at 1 year follow up there was some evidence of relapse. The correction achieved was, however, superior to that achieved before this method. None of the relapses were deemed severe enough to warrant further surgery at this stage.

CONCLUSIONS

This method of nasal correction is recommended to achieve superior outcomes in the surgical treatment of unilateral cleft lips.