Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability

2020 ◽  
Vol 57 (6) ◽  
pp. 700-706
Author(s):  
Neha Bhutiani ◽  
Tulika Tripathi ◽  
Mahesh Verma ◽  
Padam Singh Bhandari ◽  
Priyank Rai
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Treatment Time ◽  
Percentage Increase ◽  
Morphological Parameters ◽  
Arch Form ◽  
Width Difference ◽  
Nasoalveolar Molding

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.

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.

scholarly journals Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate

2016 ◽  
Vol 7 (4) ◽  
pp. 569 ◽  
Author(s):  
PrabhakarRamasetty Attiguppe ◽  
YM Karuna ◽  
Chandrashekar Yavagal ◽  
SaraswathiV Naik ◽  
BM Deepak ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Nasoalveolar Molding

scholarly journals The First-Year Follow-Up of a Cleft Lip and Palate Patient Treated With Nasoalveolar Molding (NAM)

2020 ◽  
Vol 31 (2) ◽  
pp. 190-196
Author(s):  
Nathália Viegas de Oliveira ◽  
Gabriel Antônio Anjos Tou ◽  
Raquel Souto Silva ◽  
Sérgio Edriane Rezende ◽  
Henrique Pretti ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Operative Therapy ◽  
First Year ◽  
Treatment Morbidity ◽  
One Step ◽  
Nasoalveolar Molding

Abstract The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient’s lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

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.

A Rapid Solution to Align the Severely Malpositioned Premaxilla in Bilateral Cleft Lip and Palate Patients

2008 ◽  
Vol 45 (3) ◽  
pp. 229-231 ◽  
Author(s):  
Amornpong T. Vachiramon ◽  
John N. Groper ◽  
Simon Gamer
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Time ◽  
Bilateral Cleft Lip ◽  
Nasoalveolar Molding ◽  
Presurgical Orthopedics ◽  
Palate Patient

Objective: To describe a laboratory modification of the maxillary cast to make an improved nasoalveolar molding plate used in presurgical orthopedics for infants with bilateral cleft lip and palate. Conclusions: Modifying the nasoalveolar molding plate may reduce the presurgical treatment time for the bilateral cleft lip and palate patient.

scholarly journals A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicole M. Kurnik ◽  
Mert Calis ◽  
Danielle L. Sobol ◽  
Hitesh Kapadia ◽  
Ezgi Mercan ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Comparative Assessment ◽  
Nasoalveolar Molding

An Intraoral Appliance to Retract the Protrusive Premaxilla in Bilateral Cleft Lip Patients Presenting Late for Primary Lip Repair

2018 ◽  
Vol 55 (4) ◽  
pp. 622-625 ◽  
Author(s):  
Nandagopal Vura ◽  
Rajasekhar Gaddipati ◽  
Yudhistar Palla ◽  
Pranay Kumar
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Time ◽  
Glass Ionomer Cement ◽  
Nickel Titanium ◽  
Glass Ionomer ◽  
Retention Period ◽  
The Mean ◽  
Nasoalveolar Molding ◽  
Ionomer Cement

The protruding and deviated premaxilla in bilateral complete cleft lip and palate (BCL/P) patients causes a perplexing problem in achieving a tension-free primary lip closure. An innovative noninvasive active intraoral Fixed Pre-Surgical Cleft Orthopedic (FPSCO) appliance is presented that has enabled to successfully reposition the premaxillary segment to a more favorable position prior to the surgical repair in 4 BCL/P patients, who reported late for treatment with a mean age of 18 ± 3 months. All the patients had at least 1 deciduous tooth erupted in 3 cleft segments, 1 premaxilla (PM), and 2 lateral maxillary (LM) segments. This innovative approach is a noninvasive method of getting the cleft segments closer prior to chelioplasty, where conventional presurgical nasoalveolar molding (PNAM) is not possible, which needs to be done early in life as it requires circulating maternal estrogen levels to achieve results preferably possible in patients younger than 3 to 6 months. Bonding to erupted teeth with glass ionomer cement was implemented to secure the appliance. Nickel-titanium (Ni-Ti) closed-coil springs were used that delivered continuous forces of 150 g/5 oz per side to retract the premaxillary segment. The mean active period of treatment time was 3.5 ± 1.6 months and the retention period was 1.2 ± 0.6 months, following which cheiloplasty was performed.

The Effects of Nasoalveolar Molding on Nasal Proportions at the Time of Nasal Maturity

2020 ◽  
pp. 105566562095013
Author(s):  
Samantha G. Maliha ◽  
Rami S. Kantar ◽  
Marina N. Gonchar ◽  
Bradley S. Eisemann ◽  
David A. Staffenberg ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Intrarater Reliability ◽  
Exclusion Criteria ◽  
Subjective Analysis ◽  
Nasolabial Angle ◽  
Syndromic Diagnosis ◽  
Grading Scale ◽  
Nasoalveolar Molding

Background: The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity. Methods: A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners. Results: Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM. Conclusion: The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.

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