Nasoalveolar Molding and Long-Term Postsurgical Esthetics for Unilateral Cleft Lip/Palate: 5-Year Follow-Up

2011 ◽  
Vol 20 (7) ◽  
pp. 577-582 ◽  
Author(s):  
Pravinkumar G. Patil ◽  
Smita P. Patil ◽  
Soumil Sarin
Keyword(s):  
Cleft Lip ◽  
Cleft Lip Palate ◽  
Nasoalveolar Molding

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

2018 ◽  
Vol 55 (7) ◽  
pp. 935-940 ◽  
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.

scholarly journals Feeling Normal? Long-Term Follow-up of Patients with a Cleft Lip–Palate after Rhinoplasty with the Derriford Appearance Scale (DAS-59)

2016 ◽  
Vol 32 (02) ◽  
pp. 219-224 ◽  
Author(s):  
Andreas Reichelt ◽  
Gilbert Nolst-Trenité ◽  
Dirk Menger ◽  
Andreas Albers
Keyword(s):  
Cleft Lip ◽  
Long Term Follow Up ◽  
Cleft Lip Palate

scholarly journals A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

2020 ◽  
Vol 53 (03) ◽  
pp. 371-376
Author(s):  
Tulasi Nayak ◽  
Renu Parmar ◽  
Krishnamurthy Bonanthaya ◽  
Pritham Shetty
Keyword(s):  
Longitudinal Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Conclusive Evidence ◽  
Long Term Stability ◽  
Alar Base ◽  
Gradual Loss ◽  
Nasoalveolar Molding

Abstract Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

The Impacts and Outcomes of Presurgical Nasoalveolar Molding (PNAM) in Newborn Sequential Therapeutic Implementation

2021 ◽  
Author(s):  
Vonda Trivosa
Keyword(s):  
Incidence Rate ◽  
Rural Areas ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Deciduous Dentition ◽  
Parents And Children ◽  
Nasoalveolar Molding

Cleft lip and palate is a common congenital malformation in the oral and maxillofacial regions. According to epidemiological investigation, the incidence rate is about 1.625%, and the incidence rate is high in poor areas and rural areas. Cleft lip and palate mainly involve the upper lip, hard palate, soft palate and nose, which can damage the appearance of children, affect pronunciation, swallowing and chewing, and also bring different degrees of psychological damage to children in the growth stage. Therefore, we should actively carry out sequential treatment and participate in the treatment work through multi-disciplines. Based on restoring the oral and maxillofacial function and health of children, we should also pay attention to their aesthetic needs, enhance the treatment confidence of parents and children, and lay the foundation for the follow-up repair treatment. Most patients with cleft lip and palate are complicated with malocclusion. Orthodontic treatment is an important part of the treatment of cleft lip and palate. The orthodontic treatment of cleft lip and palate can be divided into five periods: newborn period, deciduous dentition period, mixed dentition period, permanent dentition period and combined orthodontic and orthognathic treatment period. Presurgicalnasoalveolar molding (PNAM) was used to reduce the severity of facial deformity in children with cleft lip and palate. This article discusses the therapeutic effect of newborn PNAM according to clinical cases. Objective to study the opportunity and current situation of PNAM in the treatment of children with cleft lip and palate, and to provide a favorable reference for clinical orthodontists, emphasizing the close communication between various disciplines.

Controversies in Cleft Rhinoplasty

2020 ◽  
Vol 36 (01) ◽  
pp. 102-111 ◽  
Author(s):  
Steven G. Hoshal ◽  
Roberto N. Solis ◽  
Travis T. Tollefson
Keyword(s):  
Cleft Lip ◽  
Great Variability ◽  
Cartilage Grafts ◽  
Aesthetic Appearance ◽  
Cleft Lip Palate ◽  
Cleft Rhinoplasty ◽  
Tailored Approach ◽  
Nasoalveolar Molding

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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