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R V, Singhal R, Namdev R, Kumar A, Dayma C, Rani A. Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2024:10556656241249822. [PMID: 38711400 DOI: 10.1177/10556656241249822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate. DESIGN An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach. MAIN OUTCOME MEASURES Nasolabial Aesthetics, Dentoalveolar Relationship. RESULTS A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low. CONCLUSION When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.
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Affiliation(s)
- Vignesh R
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ruchi Singhal
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Ritu Namdev
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Adarsh Kumar
- Department of Public Health Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Charu Dayma
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
| | - Asha Rani
- Department of Pediatric and Preventive Dentistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
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H AK, Batra P, Juneja A, Talwar A, Mohan S, Sood SC. 3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial. Cleft Palate Craniofac J 2024:10556656241246923. [PMID: 38644766 DOI: 10.1177/10556656241246923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. DESIGN Randomised clinical trial. SETTING Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). INTERVENTIONS Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). MAIN OUTCOME MEASURE(S) Changes in facial and nasolabial morphology. RESULTS Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. CONCLUSIONS Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.
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Affiliation(s)
- Alisha K H
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics & Dentofacial Orthopaedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Achint Juneja
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Aditya Talwar
- Department of Orthodontics & Dentofacial Orthopaedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Stuti Mohan
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - S C Sood
- Smile Train Centre, Sant Paramanand Hospital, Delhi, Delhi, India
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Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, Santiago PE. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J 2024; 61:654-677. [PMID: 36330703 DOI: 10.1177/10556656221136325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. MAIN OUTCOME MEASURES Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. RESULTS A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. CONCLUSIONS Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
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Affiliation(s)
| | | | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Andrew Hollins
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Ronnie Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Alexander C Allori
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Pedro E Santiago
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
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Shivanna MP, Hiriyanna NM, Kumar H, Athreya SV. Dynamic Molding of Cleft Nasal Cartilage in Unilateral Complete Cleft Lip and Palate Using Simple Segmented NAM. J Maxillofac Oral Surg 2023; 22:946-953. [PMID: 38105845 PMCID: PMC10719226 DOI: 10.1007/s12663-023-01980-x] [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: 09/20/2022] [Accepted: 07/19/2023] [Indexed: 12/19/2023] Open
Abstract
Objective Nasal morphology remodeling by nasoalveolar molding (NAM) before primary lip repair gives better post-surgery outcomes. However, traditional NAM has high technical sensitivity, a steep learning curve, frequent need for modifications, and interrupts lifting forces on the nasal cartilage during oral movements, thereby reducing overall efficacy of device. To eliminate interaction and interdependency of the nasal bulb with alveolar molding plate, we propose segmenting NAM (SNAM) into nasolabial complex molding (NCM) and alveolar complex molding (ACM). NCM addresses ala-septum, lip-premaxilla via lambda-nasal hook and lip taping. ACM addresses palate-alveolus via Yen-modified feeding plate. When the hook is suspended by elastic traction, nasal complex undergoes a natural rotation, where cleft-side ala lifts and septum medializes. Lip taping and feeding plate augment positive molding of cleft segments and maintain transverse relation. The current study outlines SNAM treatment strategy and assesses the effect on nasal deformity. Design and setting Retrospective observational cohort study set in a comprehensive cleft care centre. Patients Twenty patients with unilateral complete cleft lip and palate who underwent SNAM were selected. Main outcome measures Retrospectively, standardized basilar views, pre-, and post-SNAM therapy were evaluated for nostril height, and nostril width, as a ratio of cleft to non-cleft side along with columellar deviation angle. Results SNAM resulted in significantly improved nostril symmetry with no complications observed. Nostril height ratio increased from 0.35 ± 0.10 to 0.78 ± 0.17. Nostril width ratio decreased from 3.14 ± 0.66 to 2.18 ± 0.42. Columellar deviation angle increased from 26.5 ± 6.30 to 58.5 ± 9.88 degrees. Conclusions Dynamic correction of the nasal deformity in UCLP is possible through SNAM therapy.
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Affiliation(s)
- Manu Prasad Shivanna
- ABMSS Comprehensive Cleft Care Centre, Mysore, 570015 India
- Oral and Maxillofacial Surgery, Farooqia Dental College, Rajiv Gandhi University of Health Sciences, Mysore, 570015 India
| | | | - Harish Kumar
- ABMSS Comprehensive Cleft Care Centre, Hyderabad, 500007 India
| | - Surabhi V. Athreya
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurugram, 122505 India
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Singhal R, Negi S, Bhagol A, Namdev R. Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate. J Maxillofac Oral Surg 2023; 22:954-960. [PMID: 38105829 PMCID: PMC10719207 DOI: 10.1007/s12663-023-01993-6] [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: 02/09/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
Background Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child. Aim To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect. Material and Methods The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree. Discussion For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc. Conclusion The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.
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Affiliation(s)
| | | | - Amrish Bhagol
- Department of Oral and Maxillofacial Surgery, PGIDS, Rohtak, India
| | - Ritu Namdev
- Department of Pedodontics, PGIDS, Rohtak, India
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Hendricks H, Lypka M, Jiang S. An evaluation of the customized nasal clip protocol for bilateral cleft lip and palate presurgical infant orthopaedics. Orthod Craniofac Res 2023; 26 Suppl 1:196-203. [PMID: 37807840 DOI: 10.1111/ocr.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Nasoalveolar moulding (NAM) has resulted in profound outcomes in the treatment of bilateral cleft lip and palate patients, including non-surgical columellar lengthening and nasal moulding. We examine an innovative alternative that is less invasive, yet provides similar results. In this study, we describe a novel approach using the Customized Nasal Clip Protocol (CNCP™) and compare the treatment outcomes of a small cohort of infants with bilateral cleft lip ± palate with published results of the Grayson nasoalveolar moulding protocol. MATERIALS AND METHODS A cohort of six bilateral-cleft-affected patients was evaluated for this study. Standardized frontal and worm's eye view photographs were obtained, and clinical measurements were utilized to garner columellar length measurements and nostril height comparisons. The initial and post-surgical results were statistically compared with a student's t-test (p < .05). Inclusion and exclusion criteria were applied to the cohort, which will be described. RESULTS The resulting columellar length and nostril height increases of the CNCP™ group were comparable to a published cohort of subjects that have undergone nasoalveolar moulding. The nasal changes were found to be significant with a p-value <.01. The CNCP™ cohort also had fewer clinic visits, no complications that led to complete pauses of active treatment, and the benefit of receiving comprehensive treatment that was initiated at their first clinical presentation, in comparison to traditional NAM patients. CONCLUSION The increase of columellar length and nostril height that resulted from utilizing the CNCP™ in bilateral cleft patients met the treatment goals of presurgical infant orthopaedics, with results on par with published results of NAM. These results, paired with the reduction in patient, family, and provider burden, further support the continued use and development of the CNCP™ for appropriate patient populations.
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Affiliation(s)
- Heather Hendricks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- Division of Orthodontics, Department of Dentistry, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Michael Lypka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Shao Jiang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
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Aycart MA, Caterson EJ. Advances in Cleft Lip and Palate Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1932. [PMID: 38003981 PMCID: PMC10672985 DOI: 10.3390/medicina59111932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Cleft lip with or without cleft palate is one of the most common congenital malformations, with an average prevalence of 1 in 1000 live births. Cleft lip and/or palate is incredibly phenotypically diverse, with constant advancements and refinements in how we care for patients. This article presents an in-depth review of the latest advances and current evidence in cleft lip and palate surgery. This includes presurgical infant orthopedics, perioperative practice patterns including use of enhanced recovery after surgery (ERAS) protocols, patient-reported outcome measures, and the latest adjuncts in cheiloplasty and palatoplasty.
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Affiliation(s)
- Mario A. Aycart
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Nemours Children’s Health-Delaware, 1600 Rockland Road, Wilmington, DE 19803, USA;
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Batra P, Gribel BF, Abhinav BA, Raghavan S, Arora A. A comparative evaluation of presurgical infant orthopedics of modified Grayson's technique with clear aligners incorporating a nasal elevator in patients with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:714-727. [PMID: 35981905 DOI: 10.1016/j.ajodo.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the differences between 2 methods of presurgical infant orthopedics: the modified Grayson's technique and a new technique using clear aligners in patients with complete unilateral cleft lip and palate. METHODS For this prospective comparative cohort study, 30 patients were divided into 2 groups: group A (modified Grayson technique) and group B (clear aligner trays), with 15 patients each. Scanned cast measurements were taken before and after treatment and evaluated using an appropriate 3-dimensional software assessing treatment changes in the alveolus (eg, reduction of width between major and minor segment, angulation change of each respective segment [intragroup and intergroup, respectively]). This was supplemented with standardized anterioposterior, Worms-eye view, and profile photographs assessing changes in columellar angle, nostril width, height, nasolabial angle, and soft-tissue cleft gap. Furthermore, the number of visits for each patient group was also tabulated and assessed. The differences were compared using the independent t test and Mann-Whitney U test for the respective parameters. RESULTS Groups A and B showed similar posttreatment changes, with no overt significant differences. However, there was a statistically significant difference in the number of visits (P <0.05), with group B having much lower visits to the center than group A. The posttreatment values matched previously established growth reference values. The analysis of photographic measurements showed improved nasal asymmetry in both groups without any significant difference. CONCLUSIONS Because there was no difference in the treatment results between the 2 methods and a reduction in the number of required patient visits, presurgical infant orthopedics via clear aligners could pave the way for a more patient-efficient approach.
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Affiliation(s)
- Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - B A Abhinav
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - Anika Arora
- Manav Rachna Dental College, Faridabad, Haryana, India
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Current Presurgical Infant Orthopedics Practices Among American Cleft Palate Association–Approved Cleft Teams in North America. J Craniofac Surg 2022; 33:2522-2528. [DOI: 10.1097/scs.0000000000008790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/23/2022] Open
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ElNaghy R, Amin SA, Hasanin M. Evaluating the accuracy of intraoral direct digital impressions in 2 infants with unilateral cleft lip and palate compared with digitized conventional impression. Am J Orthod Dentofacial Orthop 2022; 162:403-409. [DOI: 10.1016/j.ajodo.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
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Batra P, Datana S, Arora A. Presurgical infant Orthopedics: A developmental and clinical evolution. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_40_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gonca M, Ozel MB. A modified presurgical alveolar molding technique for treatment of cleft in Down syndrome. Korean J Orthod 2021; 51:428-434. [PMID: 34803031 PMCID: PMC8607116 DOI: 10.4041/kjod.2021.51.6.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
Craniofacial clefts are extremely rare deformities. Tessier’s classification is a widely accepted system that is based on clinical, radiographical, and surgical observations. The Tessier No. 0 cleft most commonly affects the upper lip, nose, and palate. This case presentation aims to report the outcome of a modified presurgical alveolar molding (PAM) appliance used in the treatment of an infant with Tessier No. 0 cleft as an alternate approach to mold such defects before surgery. The modified PAM appliance consisted of reciprocal parts connected by a helix. The segments were approximated by stripping the appliance at the midline in a V-shaped manner and the force was exerted by the extraoral elastics. The procedure gave results in 8 weeks, which may be regarded as a reasonable duration. The anterior cleft gap, which was 13 mm before the treatment, was reduced to 3 mm after the treatment by using modified PAM appliance. On a 21-month follow-up period, oral reshaping was regarded successful due to stability of the improved oral mold.
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Affiliation(s)
- Merve Gonca
- Department of Orthodontics, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Mehmet Birol Ozel
- Department of Orthodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Aihara Y, Yanagawa T, Sasaki M, Sasaki K, Shibuya Y, Adachi K, Togashi S, Takaoka S, Tabuchi K, Bukawa H, Sekido M. Nasal molding prevents relapse of nasal deformity after primary rhinoplasty in patients with unilateral complete cleft lip: An outcomes-based comparative study of palatal plate alone versus nasoalveolar molding. Clin Exp Dent Res 2021; 8:197-208. [PMID: 34689427 PMCID: PMC8874052 DOI: 10.1002/cre2.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives In recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors. Materials and methods The patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left–right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc‐Grn∠midline and midline∠columellar axis). Results The area ratio, perimeter ratio, and Grc‐Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months. Conclusions The results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.
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Affiliation(s)
- Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoichiro Shibuya
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koji Adachi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Togashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuhiko Tabuchi
- Department of Molecular and Cellular Physiology, Institute of Medicine, Academic Assembly, Shinshu University, Nagano, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Complications During Grayson Presurgical Nasoalveolar Molding Method in Nonsyndromic Infants With Complete Unilateral Cleft Lip and Palate. J Craniofac Surg 2021; 32:2159-2162. [PMID: 34516070 DOI: 10.1097/scs.0000000000007532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Within the treatment protocols of patients with cleft lip and palate, the nasoalveolar molding (NAM) acquire more followers every day.Their benefits have been well documented, but not equally their complications. The purpose of this study was to describe the complications produced during treatment with Grayson presurgical NAM in nonsyndromic infants with complete unilateral cleft lip and palate. METHODS Bibliographic review on 8 databases using search algorithms. By applying the exclusion and inclusion criteria, 21 articles were detected, which were analyzed in full text. Complication, cause, and solution data were presented in supplemental tables. RESULTS Complications are related to soft tissues, hard tissues, and those derived from care. SOFT TISSUES irritation, ulceration, gingival, facial, or nasal bleeding. Candidiasis. An overexpanded nostril creation to improper placement or modifications of the nasal stent at home.The most frequent were lip and cheeks skin irritation by taping, and gingival ulceration due to excessive pressure. HARD TISSUES misalignment of alveolar segments and the premature eruption of teeth. DERIVED FROM CARE inadequate device retention, adherence problems to treatment, poor/excessive care of the caregiver, intolerance to the device, eating problems, breathing, and socioeconomic issues. CONCLUSIONS The main complications occur in soft tissues, related to the retention mechanisms and an inadequate adjustment of the device.The benefits of NAM exceed the complications. It is necessary to know them to avoid any harmful results since they could prolong or stop the treatment, compromising the result. The active collaboration of the family in the insertion and maintenance of the device is crucial for success.
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Kalaskar R, Bhaje P, Sharma P, Balasubramanian S, Ninawe N, Ijalkar R. Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial. J Korean Assoc Oral Maxillofac Surg 2021; 47:257-268. [PMID: 34462383 PMCID: PMC8408650 DOI: 10.5125/jkaoms.2021.47.4.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/04/2021] [Indexed: 11/07/2022] Open
Abstract
Objectives Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. Materials and Methods Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. Results Groups A and B did not differ significantly in any extraoral or intraoral parameter. Conclusion The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in com-plete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
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Affiliation(s)
- Ritesh Kalaskar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Bhaje
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Sharma
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Shruti Balasubramanian
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Nupur Ninawe
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Rajesh Ijalkar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
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Hinostroza-Flores M, Perona-Miguel de Priego GA, Loo-Valle J. [Pre-surgical orthopedic treatment with Hinostroza nasal retractor modification in complete unilateral palate fissure. Case report]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e065. [PMID: 38465277 PMCID: PMC10919824 DOI: 10.21142/2523-2754-0902-2021-065] [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] [Received: 04/24/2021] [Accepted: 06/02/2021] [Indexed: 03/12/2024] Open
Abstract
Complete unilateral palatine fissure affects the region of the middle facial third and individuals born with this condition have altered structures on the side where the malformation developed. The objective of the present case report was to describe a pre-surgical orthopedics alternative in a female infant of 1 month 5 days of age with complete unilateral palatine fissure diagnosed with complete unilateral left palatine fissure. The Hinostroza nasal retractor modification was placed, allowing symmetry to the affected nasal structure with respect to the unaffected side. This procedure provides good results, low cost and easy handling and should be considered as an alternative treatment in neonates born with complete unilateral palatine fissure.
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Affiliation(s)
- Manuel Hinostroza-Flores
- Maestría de Odontopediatría, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Maestría de Odontopediatría Universidad Científica del Sur Lima Peru
| | - Guido Alberto Perona-Miguel de Priego
- Maestría de Odontopediatría, Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur Maestría de Odontopediatría Universidad Científica del Sur Lima Peru
| | - Jennifer Loo-Valle
- Especialidad de Odontopediatría, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Especialidad de Odontopediatría Universidad Científica del Sur Lima Peru
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Garland K, McNeely B, Dubois L, Matic D. Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes. Cleft Palate Craniofac J 2021; 59:156-165. [PMID: 33678051 PMCID: PMC8750140 DOI: 10.1177/1055665621998176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To perform a systematic review of the literature to identify the long-term
effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed
to identify all English-language publications related to unilateral cleft
lip and palate, presurgical devices, and patient outcomes. Studies were
excluded if they did not report patient outcomes beyond 2 years of age, did
not describe the use of a PSO device, were case reports (n < 10), or were
purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were
selected for inclusion. Overall, there was no reported consensus as to the
long-term effects of PSO devices. Furthermore, this study identified that
only 10% of published research controlled for confounding factors that could
influence the reported results. Confounding factors that were identified
included different operating surgeon, different surgical protocols, and
different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly,
there is no consensus in the literature about the long-term effects of PSO
devices on long-term patient outcomes. Secondly, research in this domain is
limited by confounding factors that influence the applicability of the
reported results.
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Affiliation(s)
- Katie Garland
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Brendan McNeely
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Damir Matic
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
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A Three-Dimensional Study of the Nasolabial Soft Tissue Symmetry in Children With Unilateral Complete Cleft Lip and Palate Using Traditional and Split-Type Nasoalveolar Molding. J Craniofac Surg 2021; 31:1785-1789. [PMID: 32569046 DOI: 10.1097/scs.0000000000006593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement. METHODS A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients' craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software. RESULTS After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups. CONCLUSIONS The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.
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Abhinav BA, Batra P, Chander Sood S, Sharma K, Srivastava A, Raghavan S. Comparative Study of Presurgical Infant Orthopedics by Modified Grayson Method and Dynacleft With Nasal Elevators in Patients With Unilateral Cleft Lip and Palate-A Clinical Prospective Study. Cleft Palate Craniofac J 2020; 58:189-201. [PMID: 32840133 DOI: 10.1177/1055665620948630] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the effects of presurgical infant orthopedics using 2 different methods, that is, the Dynacleft with Nasal elevator system versus the modified Grayson's technique in patients with complete unilateral cleft lip and palate. DESIGN Prospective comparative cohort study. MATERIALS AND METHODS Twenty-eight patients were divided into 2 groups, that is, Group A consisting of 14 patients who underwent correction with DynaCleft with Nasal elevator system and Group B consisting of 14 patients undergoing correction using the modified Grayson technique. Maxillary cast measurements were taken at 2-time intervals (pre- and posttreatment) to assess various parameters using a laser scanning machine (C500 Solutionix) and 3D software (GOM Inspect). Similarly, standardized anterior-posterior and worm's-eye view photographs using a custom box were taken and imported to Adobe Photoshop CS6 for measurements. Paired t test and independent t test were used to compare intra- and intergroup changes, respectively. RESULTS The analysis of cast (primary outcome) and photographic (secondary outcome) measurements showed improved nasal asymmetry and alveolar correction in both groups which showed no significant intergroup difference when assessed using the independent t test (P > .05). Group A showed higher chances (42.8%) of causing a T-shaped defect (due to excessive mesial-inward rotation of the minor segment) when compared to the Group B possibly due to a more controlled molding vector (P < .05). CONCLUSION Both methods proved effective in improving the nasal asymmetry, reducing the alveolar cleft gap, and approximating the lips together; but care must be taken when applying the alveolar molding vector in the Dynacleft system.
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Affiliation(s)
- B A Abhinav
- Department of Orthodontics and Dentofacial Orthopedics, 79148Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, 79148Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | | | - Karan Sharma
- Department of Orthodontics and Dentofacial Orthopedics, 79148Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Amit Srivastava
- Department of Orthodontics and Dentofacial Orthopedics, 79148Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Sreevatsan Raghavan
- Department of Orthodontics and Dentofacial Orthopedics, 79148Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
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Bhutiani N, Tripathi T, Verma M, Bhandari PS, Rai P. Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability. Cleft Palate Craniofac J 2020; 57:700-706. [PMID: 32116001 DOI: 10.1177/1055665620906293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. DESIGN Prospective clinical trial. SETTING Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. PATIENTS Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. INTERVENTIONS Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. MAIN OUTCOME MEASURES Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. RESULTS There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. CONCLUSIONS Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.
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Affiliation(s)
- Neha Bhutiani
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Mahesh Verma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | | | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Shetty S, Shafeeq AK, Koya S, Husain A, Parveen K. Evaluation of efficacy of a novel extraoral nasoalveolar molding technique with lip taping in cleft lip and palate patients. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Batra P, Gribel BF, Abhinav BA, Arora A, Raghavan S. OrthoAligner "NAM": A Case Series of Presurgical Infant Orthopedics (PSIO) Using Clear Aligners. Cleft Palate Craniofac J 2019; 57:646-655. [PMID: 31795731 DOI: 10.1177/1055665619889807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Presurgical infant orthopedics (PSIO) is done to reduce the size of the cleft defect along with improving the arch alignment and nasolabial aesthetics in patients with cleft lip and palate, leading to an improvement of nasolabial aesthetics allowing for a tidier and more aesthetic reparative procedure and postsurgical scar. Since the 2000s, clear aligners have slowly and steadily treaded their way as an acceptable orthodontic modality, with their usage and acceptability increasing considerably over the past decade. Thus, from the knowledge gathered in its 10 years working with 3-dimensional (3-D) diagnosis, treatment planning, and 3-D Printing services, Compass 3D (Belo Horizonte, Brazil) developed the OrthoAligner NAM system. This case series highlights one of the world's first documented cases of PSIO treated with a series of clear aligners.
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Affiliation(s)
- Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Bruno Frazāo Gribel
- Compass 3D: Inteligēncia e Tecnologia para dentistas, Funcionários, Belo Horizonte, Minas Gerais, Brazil
| | - B A Abhinav
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Anika Arora
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Sreevatsan Raghavan
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
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23
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Flores RL, Shetye PR. The Nasoalveolar Molding (NAM) Treatment Protocol. Cleft Palate Craniofac J 2019; 56:1124-1125. [DOI: 10.1177/1055665619837132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Roberto L. Flores
- Cleft Lip and Palate Program, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Pradip R. Shetye
- Craniofacial Orthodontics, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
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Effectiveness of Nasoalveolar Molding in the Unilateral Cleft Lip and Cleft Palate. J Craniofac Surg 2018; 29:1522-1525. [PMID: 29944571 DOI: 10.1097/scs.0000000000004724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cleft lip and palate develops during embryogenesis due to an alteration in the fusion of the tissues which will form the upper lip and palate. The rate of occurrence in Chile is 1.6 per 1000 live births. The object of the present study was to determine the effectiveness of the Grayson nasoalveolar molding appliance in reducing the gap between the alveolar segments in cases of unilateral cleft lip and palate by sex, age at start of treatment, initial gap between the alveolar segments, and number of checkups. METHODS The study design was quasi-experimental, with measurements taken before and after surgery and no control group. The authors studied the medical records and models of a sample of 52 patients with complete unilateral cleft lip and palate who were discharged after treatment using Grayson nasoalveolar molding appliance. Treatment was considered effective when the final gap was 3 mm or less. Then the percentage of cases in which treatment was effective, applying statistical tests, including log regression, to assess the influence of other variables was calculated. RESULTS The authors observed that the Grayson nasoalveolar molding appliance was effective in 69.23% of patients. Of the variables studied, the initial gap presented statistically significant differences (initial gap of 8-12 mm, effectiveness 82.61%); in the log regression, the same variable presented a statistically significant difference in the adjusted odds of effectiveness. CONCLUSION Grayson nasoalveolar molding appliance presents good effectiveness in reducing the gap between the alveolar segments in patients with unilateral cleft lip and palate, especially in cases with a gap of 8 to 12 mm.
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25
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Evaluation of Airway Volume in Cleft Lip and Palate Following Nasoalveolar Molding. J Craniofac Surg 2018; 29:2143-2147. [DOI: 10.1097/scs.0000000000004681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment. J Craniofac Surg 2018; 29:2081-2087. [PMID: 30334916 DOI: 10.1097/scs.0000000000004888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons. METHODS Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale. RESULTS The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05). CONCLUSION Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.
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Grill FD, Ritschl LM, Dikel H, Rau A, Roth M, Eblenkamp M, Wolff KD, Loeffelbein DJ, Bauer FX. Facilitating CAD/CAM nasoalveolar molding therapy with a novel click-in system for nasal stents ensuring a quick and user-friendly chairside nasal stent exchange. Sci Rep 2018; 8:12084. [PMID: 30108232 PMCID: PMC6092331 DOI: 10.1038/s41598-018-29960-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022] Open
Abstract
Nasoalveolar molding (NAM) aims to improve nasal symmetry with a nasal stent in cleft lip and palate (CLP) patients. When plates have to be exchanged because of dentoalveolar growth or cleft reduction, the nasal stent has to be mounted onto a new plate. This procedure elongates visiting hours for patients and parents or requires second treatment sessions. This study introduces a quick-lock additive manufacturing solution for chairside nasal stent exchange called RapidNAM. A novel taping retention pin has been designed that enables nasal stent insertion. Patients with unilateral CLP were included in this study. Plaster models were digitalized and measured by two independent observers. Two methods of CAD/CAM-molding therapies were compared: (i) conventional adhesion of a nasal stent (CAD/CAM NAM); (ii) quick-lock system in which the nasal stent was transferred to another plate (RapidNAM). CAD/CAM NAM and its refinement RapidNAM significantly increased the cleft-side nasal height and tilted the nose towards symmetry. The quick-lock system minimizes wire adaptations, since the pre-existing stent can be reused. The new nasal stent development seems a feasible solution to minimize visiting hours but with clinically satisfactory results. This new nasal stent system combines traditional elements of NAM with CAD/CAM-technology.
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Affiliation(s)
- Florian D Grill
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Hannes Dikel
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Roth
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Markus Eblenkamp
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany.,Department of Oral and Maxillofacial Surgery, Helios Hospital Munich West, Teaching Hospital of Ludwig-Maximilians-Universiität, München, Germany
| | - Franz X Bauer
- Institute of Medical and Polymer Engineering, Technische Universität München, München, Germany
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Effects of Nasoalveolar Molding Therapy on Alveolar and Palatal Cleft Deformities in Unilateral and Bilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:e179-e184. [PMID: 29381641 DOI: 10.1097/scs.0000000000004243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the efficacy of nasoalveolar molding (NAM) therapy in the improvement of alveolar and palatal cleft deformity on unilateral (UCLP) versus bilateral (BCLP) cleft lip and palate. MATERIALS AND METHODS A total of 19 UCLP (14 boys and 5 girls) and 8 BCLP (7 boys and 1 girl) infants completed NAM therapy were included in this study. Standardized parameters of cleft width of alveol and palate were measured on photocopies taken from the pre- and post-treatment plaster casts. To assess the intragroup differences, paired-samples test in UCLP and Wilcoxon test in BCLP groups were used. Mann-Whitney U test was used to evaluate the differences between the groups. RESULTS Significant decreases in alveolar and palatal cleft gaps were achieved in an average period of 3.3 ± 1.9 and 3.7 ± 1.6 months in UCLP and BCLP patients, respectively. The alveolar cleft decreased 7.85 ± 4.59 mm in UCLP and 4.25 ± 3.13 and 3.81 ± 3.50 mm in right and left alveolar cleft sides in BCLP, respectively. The palatal clefts were decreased 4.63 ± 2.44 mm in medial and 3.72 ± 2.62 mm in posterior parts in UCLP. The decrements in BCLP were 3.00 ± 2.75 mm in medial and 2.88 ± 2.75 mm in posterior palatal cleft distances. No significant differences were determined in the amount of alveolar or palatal cleft closure between UCLP and BCLP groups. The only decrease in arch width was 1.39 mm in medial part of palate in UCLP. CONCLUSION The NAM device provides significant decreases in both alveolar and palatal cleft deformities in UCLP and BCLP infants, as compared with their birth status.
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Elizondo R, Lagravère MO, Flores E, Letechipía N. Presurgical Preparation of Infants With Unilateral Cleft Lip and Palate: The SAC-PP-MR Innovative Technique. Cleft Palate Craniofac J 2018; 56:408-414. [PMID: 29906221 DOI: 10.1177/1055665618780980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this article, we demonstrate an effective, cheap, and fast way to shape the nasal alar cartilage in patients with unilateral cleft lip and palate. This technique straightens the vomer and brings the philtrum, columella, premaxilla, and the maxillary frenum to the midsagittal plane, while the alveolar ridges are shaped and positioned. This reduces the lip and palatal cleft to zero even in a 4-week period.
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Affiliation(s)
| | - Manuel O Lagravère
- 2 Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Esthela Flores
- 1 Casa Azul, A.C., San Pedro Garza Garcia, Nuevo León, Mexico.,3 University of Valencia, Valencia, Spain
| | - Nora Letechipía
- 1 Casa Azul, A.C., San Pedro Garza Garcia, Nuevo León, Mexico
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Abstract
OBJECTIVE The specific aim of this retrospective cross-sectional study was to assess the efficacy of DynaCleft® as a method of presurgical orthopedics with infants with a unilateral cleft lip and cleft palate who used an oral obturator. STUDY DESIGN Data was collected from 25 infants all of comparable age diagnosed with a unilateral complete cleft lip and palate. Eight patients used DynaCleft ® and an obturator (Group Alpha) and seventeen patients only had an obturator (Group Beta). Maxillary impression casts were obtained from each patient at the initial clinic visit and at the time of cleft lip repair. Differences in alveolar cleft width were compared between the two groups. Casts were measured twice by one observer using a digital caliper. RESULTS Group Alpha began treatment on an average age of 24.25 days and Group Beta an average of 15.35 days of age. The average cleft width of Group Alpha was 8.13 mm and after treatment it was 4.59 mm. The average cleft width of Group Beta was 8.09 mm and 6.92 mm after treatment. Results of paired t-tests and two-sample t-test showed that cleft width changes between the two groups were significant (P = .03). CONCLUSIONS DynaCleft ® significantly decreased the size of the alveolar cleft width compared to infants who did not use it. Providers should consider using DynaCleft® for patients who may not have access to infant maxillary orthopedics.
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Chou PY, Hallac RR, Ajiwe T, Xie XJ, Liao YF, Kane AA, Park YJ. The role of Nasoalveolar molding: A 3D Prospective analysis. Sci Rep 2017; 7:9901. [PMID: 28852137 PMCID: PMC5575095 DOI: 10.1038/s41598-017-10435-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/09/2017] [Indexed: 12/02/2022] Open
Abstract
Nasoalveolar molding (NAM) is commonly employed to reduce the alveolar segments into proper alignment and to improve nasal symmetry in patients with cleft lip and palate. This study examines the periodical progression of NAM treatment over time. 20 patients with complete unilateral cleft lip and palate were prospectively recruited. A 2 stage NAM treatment protocol was applied. Stage 1 involved adjustment of the alveolar segments (mean age 15.6 days), while Stage 2 added nasal stents and started average 43 days after stage 1. 3D images (n = 241) were obtained prior to NAM initiation and weekly until the end of treatment. The cleft lip area, bilateral nostril areas, and the nostril height and width were measured. Treatment was assessed in the Cleft (C) side and the Non-cleft (N). There was significant difference in the C/N ratio of the nostril area, width, and height at pre-treatment (0.9 ± 0.3, 4.1 ± 1.1, and 0.5 ± 0.2), at the end of stage 1 (1.1 ± 0.3, 2.2 ± 0.6, and 0.8 ± 0.2), and at the end of stage 2 treatment (1.8 ± 0.3, 1.8 ± 0.4, and 1.2 ± 0.1); p < 0.05. Comparative 3D analysis with dense sampling offers a precise methodology for showing effects of NAM treatment. The morphological changes achieved with NAM therapy occur in early treatment phase.
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Affiliation(s)
- Pang-Yun Chou
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rami R Hallac
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic Surgery, UT Southwestern, Dallas, TX, United States
| | - Tochi Ajiwe
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States
| | - Xian-Jin Xie
- Department of Clinical Sciences & Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, Texas, United States
| | - Yu-Fang Liao
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alex A Kane
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic Surgery, UT Southwestern, Dallas, TX, United States
| | - Yong Jong Park
- Department of Orthodontics, Children's Health Children's Medical Center, Dallas, Texas, United States.
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Smith KS, Henry BT, Scott MA. Presurgical Dentofacial Orthopedic Management of the Cleft Patient. Oral Maxillofac Surg Clin North Am 2017; 28:169-76. [PMID: 27150304 DOI: 10.1016/j.coms.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Over the last decade, presurgical orthopedic molding for the patient with cleft lip and palate has become much more common; it is even reasonable to assume it may be the standard of care for those wide unilateral and bilateral clefts with substantial dentofacial deformities. In 2013, there was a comparative study of nasoalveolar molding methods, comparing the Grayson-NAM device and DynaCleft. The results showed the 2 to be equivocal with both methods significantly reducing the cleft width and improving the nasal asymmetry.
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Affiliation(s)
- Kevin S Smith
- JW Keys Cleft and Craniofacial Clinic, A Smile for a Child Foundation, University of Oklahoma, Oklahoma City, OK, USA; MK Chapman Cleft and Craniofacial Clinic, University of Tulsa, Tulsa, OK, USA.
| | - Byron T Henry
- University of Oklahoma, Oklahoma City, OK, USA; Free to Smile Foundation, Columbus, OH, USA
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Maillard S, Retrouvey JM, Ahmed MK, Taub PJ. Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review. J Oral Maxillofac Res 2017; 8:e2. [PMID: 29142654 PMCID: PMC5676312 DOI: 10.5037/jomr.2017.8302] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair. MATERIAL AND METHODS A literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals ("Cleft Palate-Craniofacial Journal", "Plastic and Reconstructive Surgery Journal" and "American Journal of Orthodontics and Dentofacial Orthopaedic") from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology. RESULTS Of the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking. CONCLUSIONS Based on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.
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Affiliation(s)
- Sophie Maillard
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Jean-Marc Retrouvey
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Mairaj K. Ahmed
- Departments of Dentistry/Oral/Maxillofacial Surgery, Otolaryngology, and Surgery. Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
| | - Peter J. Taub
- Departments of Dentistry, Pediatrics, Surgery and Medical Education, Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
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Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1340. [PMID: 28740766 PMCID: PMC5505827 DOI: 10.1097/gox.0000000000001340] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
Background: The optimal timing for cleft lip repair has yet to be established. Advances in neonatal anesthesia, along with a growing body of literature, suggesting benefits of earlier cleft lip and nasal repair, have set the stage for a reexamination of current practices. Methods: In this prospective study, cleft lip and nasal repair occurred on average at 34.8 days (13–69 days). Nasal correction was achieved primarily through molding the nasal cartilage without the placement of nasal sutures at the time of repair. A standardized anesthetic protocol aimed at limiting neurotoxicity was utilized in all cases. Anesthetic and postoperative complications were assessed. A 3-dimensional nasal analysis compared pre- and postoperative nasal symmetry for unilateral clefts. Surveys assessed familial response to repair. Results: Thirty-two patients were included (27 unilateral and 5 bilateral clefts). In this study, the overall complication rate was 3.1%. Anthropometric measurements taken from 3-dimensional-image models showed statistically significant improvement in ratios of nostril height (preoperative mean, 0.59; postoperative mean, 0.80), nasal base width (preoperative mean, 1.96; postoperative mean, 1.12), columella length (preoperative mean, 0.62; postoperative mean, 0.89; and columella angle (preoperative mean, 30.73; postoperative mean, 9.1). Survey data indicated that families uniformly preferred earlier repair. Conclusions: We present evidence that early cleft lip and nasal repair can be performed safely and is effective at improving nasal symmetry without the placement of any nasal sutures. Utilization of this protocol has the potential to be a paradigm shift in the treatment of cleft lip and nasal deformity.
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Abstract
Severe forms of bilateral cleft lip and palate remain a challenging issue. Although nasoalveolar molding dramatically improves overall treatment success, the position of the premaxilla often remains dislocated. The authors attempted to relocate the malpositioned premaxilla into the correct position to obtain the correct three-dimensional (3D) maxillary arch structure and growth. Eight patients with severe bilateral cleft lip and palate were treated with premaxillary osteotomy for premaxilla repositioning. The position of the premaxilla was measured directly using cephalometry. Two raters including orthodontists evaluated the 3D (anteroposterior, transverse, and sagittal) outcomes. Regarding the long-term effects of premaxillary repositioning on midfacial growth, 3D computed tomography scan data were used, including the measurement of the SNA, SNB, and ANB angles according to the time period (T0: preoperative; T1: immediate postoperative; T2: long-term postoperative). All bilateral cleft lips and palates were satisfactorily repaired without any complications, including any premaxillary vascular compromise, nonunion, and occlusal instability. The average visual analog scale scores (0-5) of the anteroposterior, vertical, and transverse dimensions were 3.9, 3.7, and 3.2, respectively. Regarding the effect of premaxillary repositioning on midfacial hypoplasia, the change in the ANB between T1 and T2 was not significant, implying that premaxillary repositioning did not affect the long-term harmony between the maxilla and mandible (ANB of T2-T1: P = 0.1016) based on interim growth data at the time of follow-up and study completion. Premaxillary repositioning effectively corrected the malpositioned premaxilla and repaired the accompanying wide alveolar cleft, achieving successful restoration of maxillary arch coordination. In addition, premaxillary osteotomy after 8 years of age does not seem to cause significant maxillary retrusion.
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The Real Origin of Presurgical Nasal Molding for Cleft Nose Deformity and its Posterior Evolution. J Craniofac Surg 2017; 28:305-307. [PMID: 28060102 DOI: 10.1097/scs.0000000000003534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A modified nasoalveolar molding technique for correction of unilateral cleft nose deformity. J Craniomaxillofac Surg 2015; 43:2100-5. [PMID: 26541749 DOI: 10.1016/j.jcms.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/18/2015] [Accepted: 10/02/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Traditional Figueroa nasoalveolar molding (NAM) requires weekly or biweekly adjustments to remove acrylic from the palatal plate to narrow the alveolar gap. These frequent adjustments create a burden for patients living far from a hospital. To minimize this burden, we developed a modified NAM technique using simplified lip taping and a passive palatal plate. Herein we present our clinical experience and outcomes using the traditional and modified methods. MATERIAL AND METHODS In this blinded, retrospective study of 66 patients with complete unilateral cleft lip and palate, 33 received the traditional NAM and 33 received the modified NAM. Pretreatment and posttreatment facial photographs and clinical charts were used to compare efficacy (nostril height ratio, nostril width ratio, columellar angle, nasal base angle), efficiency (molding frequency), incidence of complications (facial irritation, mucosal ulceration), and medical cost. RESULTS Traditional and modified NAM did not differ in treatment efficacy for nostril height ratio (0.88 ± 0.14 vs. 0.90 ± 0.12), nostril width ratio (2.22 ± 0.39 vs. 2.38 ± 0.50), columellar angle (73.5 ± 9.1 degrees vs. 71.3 ± 11.8 degrees), nasal base angle (5.1 ± 2.4 degrees vs. 5.9 ± 2.7 degrees), or alveolar gap width (2.0 ± 2.0 mm vs. 2.0 ± 1.7 mm) (all p > 0.05). Traditional NAM was less efficient, i.e., required more adjustments (8.6 ± 2.0 vs. 6.7 ± 1.1), and cost more (22016.4 ± 2012.7 New Taiwan dollars vs. 20137.6 ± 1173.4 New Taiwan dollars) (both p < 0.001). CONCLUSIONS Both NAM techniques similarly improved nasal deformities and reduced alveolar gaps, but the modified technique was more efficient and cost less in terms of insurance reimbursement and supplies (labial tapes).
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Pesun IJ, Minski J, Narvey M, Pantel C, Swain V. Use of an obturator with nCPAP in a premature infant with a cleft lip and palate. J Prosthet Dent 2015; 113:493-7. [PMID: 25794910 DOI: 10.1016/j.prosdent.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
Premature infants have underdeveloped lungs and their care involves the use of nasal continuous positive airway pressure (nCPAP). For an adequate amount of oxygen to enter the lungs, the palate needs to be intact. Premature infants with a cleft lip and palate remain intubated for extended periods of time with the risks inherent in long-term intubation because of the inability to maintain nCPAP. This paper describes the fabrication of a custom-designed obturator attached to nCPAP variable flow generator tubing for a premature infant with a unilateral cleft lip and palate.
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Affiliation(s)
- Igor J Pesun
- Associate Professor, Department of Restorative Dentistry, College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - John Minski
- Neonatal Clinical Specialist, Department of Respiratory Therapy, Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Michael Narvey
- Neonatologist, Health Science Centre, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cynthia Pantel
- Nurse Practitioner, Centre for Craniofacial Differences, Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Vanessa Swain
- Associate Professor, Department of Restorative Dentistry, College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
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Çakan DG, Diren S, Nur RB. Use of Elastic Tapes in Presurgical Nasoalveolar Molding: A Case Report. Turk J Orthod 2014. [DOI: 10.13076/tjo-d-14-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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