Active Nasoalveolar molding (A-NAM) using three-directional expansion screw for arch alignment in bilateral cleft lip and palate

Objective To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate. Design A prospective study with blinded measurements. Setting The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas. Patients Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004. Interventions The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days. Main Outcome Measures Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy. Results Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased. Conclusion The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.

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Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: A novel modified presurgical nasoalveolar molding device with retraction screw

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2014.07.010 ◽

2014 ◽

Vol 42 (8) ◽

pp. 1903-1908 ◽

Cited By ~ 4

Author(s):

Wanshan Li ◽

Lishu Liao ◽

Jingbo Dai ◽

Yuxiang Zhong ◽

Leixi Ren ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Bilateral Cleft Lip ◽

Nasoalveolar Molding

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RapidNAM: generative manufacturing approach of nasoalveolar molding devices for presurgical cleft lip and palate treatment

Biomedical Engineering / Biomedizinische Technik ◽

10.1515/bmt-2016-0035 ◽

2017 ◽

Vol 62 (4) ◽

pp. 407-414 ◽

Cited By ~ 6

Author(s):

Franz Xaver Bauer ◽

Markus Schönberger ◽

Johannes Gattinger ◽

Markus Eblenkamp ◽

Erich Wintermantel ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Interdisciplinary Team ◽

Reference Target ◽

Bilateral Cleft Lip ◽

Design And Manufacturing ◽

Fixation Points ◽

Nasoalveolar Molding ◽

Ventilation Hole ◽

Prediction Factor

AbstractNasoalveolar molding (NAM) is an accepted treatment strategy in presurgical cleft therapy. The major drawbacks of the treatment listed in the literature relate to the time of the treatment and the coordination of the required interdisciplinary team of therapists, parents, and patients. To overcome these limitations, we present the automated RapidNAM concept that facilitates the design and manufacturing process of NAM devices, and that allows the virtual modification and subsequent manufacture of the devices in advance, with a growth prediction factor adapted to the patient’s natural growth. The RapidNAM concept involves (i) the prediction of three trajectories that envelope the fragmented alveolar segments with the goal to mimic a harmonic arch, (ii) the extrusion from the larger toward the smaller alveolar segment along the envelope curves toward the harmonic upper alveolar arch, and (iii) the generation of the NAM device with a ventilation hole, fixation pin, and fixation points for the nasal stents. A feasibility study for a vector-based approach was successfully conducted for unilateral and bilateral cleft lip and palate (CLP) patients. A comparison of the modified target models with the reference target models showed similar results. For further improvement, the number of landmarks used to modify the models was increased by a curve-based approach.

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