Effect of Nasoalveolar Molding in Infants with Cleft Lip & Palate

AbstractRhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip–palate are technically and intellectually challenging to master requiring a patient-tailored approach. The shape and structure of the nose are changed to improve both function and aesthetic appearance. In the primary setting, nasoalveolar molding is a form of presurgical infant orthopaedics used for preparation before the cleft lip and nose repair. Intermediate stages should be conservative to minimize scarring, while the definitive cleft rhinoplasty utilizes cartilage grafts from septum, ear, or rib to sculpt the nose. Hereinto, we will outline the controversies, the evidence supporting certain techniques, and our preferences.

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Teleconsultation-mediated nasoalveolar molding therapy for babies with cleft lip/palate during the COVID-19 outbreak: Implementing change at pandemic speed

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.05.005 ◽

2020 ◽

Vol 73 (7) ◽

pp. 1357-1404 ◽

Cited By ~ 2

Author(s):

Rafael Denadai ◽

Lun-Jou Lo

Keyword(s):

Cleft Lip ◽

Implementing Change ◽

Cleft Lip Palate ◽

Nasoalveolar Molding

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Effect of Presurgical Nasoalveolar Molding on Nasal Symmetry in Unilateral Complete Cleft Lip/Palate Patients after Primary Cheiloplasty without Concomitant Nasal Cartilage Dissection

The Cleft Palate-Craniofacial Journal ◽

10.1597/14-296 ◽

2018 ◽

Vol 55 (7) ◽

pp. 935-940 ◽

Cited By ~ 5

Author(s):

Zhigang Liang ◽

Jinfeng Yao ◽

Philip K.T. Chen ◽

Cangshang Zheng ◽

Jiying Yang

Keyword(s):

Repeated Measures ◽

Cleft Lip ◽

Early Stage ◽

Statistical Significance ◽

Deformity Correction ◽

Nasal Cartilage ◽

Significant Difference ◽

Cleft Lip Palate ◽

Nasoalveolar Molding

Objective: The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P). Design: This was a two-group, parallel, retrospective, randomized clinical trial. Setting: The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan. Patients: Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42). Interventions: Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection. Main Outcome Measures: In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance. Results: After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923). Conclusion: PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

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Comparison of Microbial Activity Among Infants With or Without Using Presurgical Nasoalveolar Molding Appliance

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620908150 ◽

2020 ◽

Vol 57 (6) ◽

pp. 762-769

Author(s):

Hanieh Hassani ◽

Jung-Wei Chen ◽

Wu Zhang ◽

William Hamra

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Pearson Correlation ◽

Bacterial Count ◽

Colony Count ◽

Caries Risk ◽

Significant Difference ◽

Cleft Lip Palate ◽

Ph Level ◽

Nasoalveolar Molding

Purpose: The aim of the current study is as follows: (1) to study whether wearing the presurgical nasoalveolar molding appliance (PNAM) had facilitated the establishment of Streptococcus mutans and Lactobacillus ( LB) and to determine other factors including pH and caries susceptibility associated with wearing the PNAM. Methods: Saliva samples of 61 infants (4.5 ± 2.06 months old) were collected from the following 3 groups: PNAM (n = 23), healthy (n = 30), and cleft lip and palate (CLP) without any treatment (n = 8). Saliva samples were assessed using selective agar to enumerate total LB and S mutans and subjected to adenosine triphosphate (ATP)-driven bioluminescence determinations using a luciferin-based assay system, and pH level was evaluated. One-way analysis of variance with least significant difference post hoc test ( P < .05) and Pearson correlation were used to evaluate S mutans, LB, pH, and ATP levels. Results: A total of 63 patients (30 healthy patients, 23 patients with cleft lip/palate who had PNAM appliance and 8 patients with cleft lip/palate who did not use the appliance) were seen in this study. There is a significant difference in pH ( P = .012), LB Caries Risk Test ( P < .001), LB colony count ( P < .001), S mutans Caries Risk Test ( P < .001), and S mutans colony count ( P < .001) among the 3 groups (PNAM > CLP > healthy). The ATP level was not significantly different among the 3 groups. Conclusion: Higher bacterial count and lower pH were found in the PNAM group. Cleft lip and/or palate patients wearing the PNAM appliance are at higher risk for dental caries.

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Nasoalveolar Molding with Active Columellar Lengthening in Severe Bilateral Cleft Lip/Palate: A Clinical Report

Journal of Prosthodontics ◽

10.1111/j.1532-849x.2012.00909.x ◽

2012 ◽

Vol 22 (2) ◽

pp. 137-142 ◽

Cited By ~ 1

Author(s):

Pravinkumar G. Patil ◽

Smita P. Patil ◽

Soumil Sarin

Keyword(s):

Cleft Lip ◽

Clinical Report ◽

Bilateral Cleft Lip ◽

Cleft Lip Palate ◽

Nasoalveolar Molding

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The effect of presurgical nasoalveolar molding (PNAM) on nasal symmetry in unilateral complete cleft lip/palate after primary cheiloplasty

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2015.08.669 ◽

2015 ◽

Vol 44 ◽

pp. e101-e102

Author(s):

Z. Liang ◽

J. Yao ◽

K.T.C. Philip ◽

C. Zheng ◽

J. Yang

Keyword(s):

Cleft Lip ◽

Cleft Lip Palate ◽

Nasoalveolar Molding

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Tatalaksana komprehensif prosedur Millard modifikasi dengan nasoalveolar molding pada labiognatopalatoskizis komplit bilateral

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v48i1.259 ◽

2018 ◽

Vol 48 (1) ◽

pp. 88

Author(s):

Dini Widiarni Widodo ◽

Raden Ayu Anatriera ◽

Taty Zubaidah Cornain

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Google Scholar ◽

Exclusion Criteria ◽

Post Surgery ◽

Clinical Presentations ◽

The Family ◽

Cleft Lip Palate ◽

Patient’S Outcome ◽

Nasoalveolar Molding

Latar belakang: Bibir sumbing dengan celah palatum merupakan suatu kelainan kongenital denganberbagai macam presentasi klinis, bersifat multifactoral inheritance dimana terdapat bakat genetikataupun kontribusi dari faktor lingkungan. Pasien cleft lip palate (CLP) membutuhkan penangananmultidisiplin untuk mengoptimalkan hasil. Penanganan sebelum dan pasca tindakan pembedahan yangkomprehensif diperlukan untuk menghasilkan outcome dan prognosis yang baik. Tujuan: Melaporkankasus labiognatopalatoskizis komplit bilateral dengan pilihan teknik labioplasti modifikasi Millard untukkoreksi primer celah bibir, disertai penggunaan nasoalveolar molding (NAM) sebelum pembedahan.Laporan kasus: Bayi laki-laki berusia 6 bulan datang dengan keluhan terdapat celah pada bibir danpalatum disertai adanya kelainan kongenital multipel sejak lahir. Hasil pemeriksaan fisik didapatkan celahpada bagian atas bibir komplit bilateral, gusi atas, serta palatum. Kavum nasi kedua hidung tampak defekpada bagian dasar hidung. Pada pasien dipasang NAM sejak usia 3 bulan agar dapat membantu asupanmenyusui. Kemudian pasien menjalani tindakan labioplasti menggunakan teknik Millard untuk koreksiprimer celah bibir. Metode: Penelitian literatur dengan mencari melalui Pubmed, Google Scholar, danClinicalKey sesuai pertanyaan klinis dalam beberapa tahun terakhir. Setelah penyaringan dengan kriteriainklusi dan eksklusi, diperoleh 1 jurnal yang relevan, selanjutnya jurnal ini dilakukan pengkajian kritis.Hasil: Dalam jurnal tersebut menyatakan bahwa penggunaan teknik modifikasi Millard dengan penggunaanNAM mempunyai outcome yang baik terhadap perbaikan bentuk bibir dan hidung pasien celah bibirkomplit bilateral. Kesimpulan: Penggunaan nasoalveolar molding sebelum pembedahan dapat bergunamenghasilkan perbaikan bentuk bibir dan hidung serta memperbaiki outcome dan prognosis pasien. ABSTRACTBackground: Cleft lip with cleft palate is either a non-syndromic disorder or a manifestation ofanother syndrome, with a variety of clinical presentations. Non-syndromic cleft lip is a multifactorialinheritance disorder in which there is a genetic tendency in the family, or being contributed byenvironmental factors. Cleft lip and cleft palate (CLP) patients need multidisciplinary managementto optimize results. A comprehensive prior and post surgery treatment are required to produce betteroutcome and prognosis. Objective: Reporting a case of complete bilateral labiognatopalatoschizis withMillard modified labioplasty approach for primary correction and the use of nasoalveolar molding(NAM) prior to surgery. Case Report: A 6-months-old male baby came with a complete bilateral cleftlip and palate, accompanied by multiple congenital abnormalities at birth. Physical examination showedcomplete bilateral cleft along lips, gums, hard and soft palate. There was also a defect at the base of thenose. In this patient, NAM was inserted since 3 months of age to assist breastfeeding intake. The patientunderwent a labioplasty procedure using Millard technique for primary correction of cleft lip. Method:Literature searching through Pubmed, Google Scholar, and ClinicalKey according to clinical questions.After screening with the inclusion and exclusion criteria, one relevant journal was obtained, then criticallyappraised. Result: The journal stated labioplasty procedure with NAM had a good outcome for lip andnose repair in a bilateral complete cleft lip. Conclusion: The use of NAM before surgery could be usefulin improving patient’s outcome and prognosis.

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