Function of Nasoalveolar Molding Devices in Bilateral Complete Cleft Lip and Palate: A 3-Dimensional Maxillary Arch Analysis

2021 ◽  
pp. 105566562199018
Author(s):  
Pawinee Tankittiwat ◽  
Araya Pisek ◽  
Montien Manosudprasit ◽  
Pattama Punyavong ◽  
Amornrut Manosudprasit ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Series ◽  
Posterior Arch ◽  
3 Dimensional ◽  
Time Points ◽  
Arch Width ◽  
Nasoalveolar Molding ◽  
Maxillary Arch

Objective: This study aimed to observe and analyze the effects of nasoalveolar molding (NAM) on maxillary arch dimensions in patients with bilateral complete cleft lip and palate (BCLP) using 3-dimensional analyses. Design: Retrospective case series. Materials and Methods: Seventeen infants were treated using modified Khon Kaen University presurgical nasoalveolar molding devices (KKU-NAM). Dental casts were evaluated 3 dimensionally at 3 time points: pretreatment (T1), after using modified KKU-NAM for 2 weeks (T2), and before cheiloplasty (T3). Repeated-measures analysis of variance and Friedman test were used to compare the maxillary arch dimensions between time points. Results: Both sides of the cleft width, premaxilla deviation, and premaxilla protrusion had significantly reduced with the use of KKU-NAM. Premaxillary rotation had significantly improved, whereas the arch depth did not change significantly. Premaxilla width, posterior arch width, alveolar length, and height had significantly increased. The anterior arch width, intercanine width, and lateral sulcus width showed no significant changes. The intraclass correlation coefficient used to test the measurements indicated substantial reliability. Conclusion: The modified KKU-NAM is an effective device for reducing the severity of bilateral cleft deformities, especially in the premaxilla area.

Short-Term Efficacy of Presurgical Vacuum Formed Nasoalveolar Molding Aligners on Nose, Lip, and Maxillary Arch Morphology in Infants With Unilateral Cleft Lip and Palate: A Prospective Clinical Trial

2020 ◽  
pp. 105566562096618
Author(s):  
Khadega Ali Al Khateeb ◽  
Mai Aboul Fotouh ◽  
Fatma Abdelsayed ◽  
Fady Fahim
Keyword(s):  
Clinical Trial ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Prospective Clinical Trial ◽  
Posterior Arch ◽  
Digital Models ◽  
Short Term ◽  
Arch Width ◽  
Nasoalveolar Molding ◽  
Maxillary Arch

Objectives: The purpose of this study was to evaluate the short-term effect of series of preadjusted vacuum formed nasoalveolar molding VF NAM aligners on the morphology of nose, lip, and maxillary arch in infants with unilateral cleft lip and palate (UCLP). Design: Prospective clinical trial. Setting: Unilateral cleft lip and palate patients referred to outpatients’ clinic. Patients: Sixteen nonsyndromic infants with UCLP, less than 2 months of age were included from April 2017 to April 2018. Interventions: All infants received VF NAM therapy. Standardized digital frontal and basilar photographs and 3D digital models were taken before initiation of VF NAM therapy (T1) and after completion of VF NAM therapy (T2). Main Outcome Measure(s): Changes in morphology of the nose, lip, and maxillary arch. Results: Statistical analysis comparing T1 and T2 measurements was performed. Frontal and basilar photographic analysis showed a statistically significant reduction of columella displacement, interlabial gap distance, and nostril width at cleft side (CS), while the nasal height, nostril height at CS, nostril width at noncleft side (NCS), columella deviation angle, nasal tip protrusion, and nostril area at both CS and NCS increased significantly with VF NAM therapy. The nasal width, nostril height at NCS showed no significant change after presurgical VF NAM aligners therapy. The analysis of digital models demonstrated a statistically significant reduction of alveolar cleft width, anterior arch width, arch length, midline deviation, and palatal cleft width, while the posterior arch width and arch perimeter increased significantly with VF NAM therapy. Conclusion: Vacuum formed NAM therapy was effective in reducing the nasoalveolar deformities associated with infants with UCLP and improved the alveolar morphology and nasal symmetry.

Presurgical Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate: A Preliminary Study

2007 ◽  
Vol 44 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Christopher F. Ezzat ◽  
Carmen Chavarria ◽  
John F. Teichgraeber ◽  
Jung-Wei Chen ◽  
Robin G. Stratmann ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Significant Positive Correlation ◽  
Cleft Lip And Palate ◽  
Average Length ◽  
Alveolar Cleft ◽  
Arch Width ◽  
Preliminary Study ◽  
A Prospective Study ◽  
Nasoalveolar Molding ◽  
Maxillary Arch

Objective: To evaluate the outcome of presurgical nasoalveolar molding (PNAM) therapy in the treatment of patients with nonsyndromic unilateral cleft and palate (UCLP). Design: A prospective study with blinded measurements. Patients: Twelve patients with UCLP treated from 1997 to 2003. Interventions: The starting age for PNAM therapy was 26 days and the average length of the therapy was 110 days. Main Outcome Measures: Measurements of intraoral and extraoral casts were made, and statistical analyses were used to compare the differences between pre- and posttherapy measurements. Results: After PNAM therapy, there was a statistically significant decrease in both intersegment alveolar cleft distance and columellar deviation (p < .05). There was also a statistically significant increase in cleft nostril height, maxillary width, and columellar width (p < .05). Moreover, although there was no statistically significant reduction of the affected nostril width, it demonstrated on average 1.7-mm reduction after PNAM therapy. The length of the time the patient utilized the appliance and postmolding nostril height were found to have a statistically significant positive correlation (p < .05). Conclusions: PNAM therapy decreases intersegment alveolar cleft distance while permitting an increase in posterior maxillary arch width. It also increases nasal symmetry by decreasing columellar deviation, increasing nostril height on the affected side, maintaining bialar width of nose, increasing columellar width, and creating more symmetrical nostril heights and widths. The improvement of the height of the cleft nostril was correlated with the time the appliance was applied.

Maxillary Arch Dimensions in Bilateral Cleft Lip and Palate from Birth until Four Years of Age in Boys

1998 ◽  
Vol 35 (3) ◽  
pp. 233-239 ◽  
Author(s):  
Kiki L.W.M. Heidbuchel ◽  
Anne M. Kuijpers-Jagtman ◽  
Gem J.C. Kramer ◽  
Birte Prahl-Andersen
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Control Group ◽  
Posterior Arch ◽  
Anterior Arch ◽  
Arch Width ◽  
Bilateral Cleft Lip ◽  
The University ◽  
Maxillary Arch

Objective To describe the development of maxillary arch dimensions in children with bilateral cleft lip and palate (BCLP) during the first 4 years of life and to compare it with that in noncleft children. Design This was a retrospective, mixed-longitudinal study. Setting The study was conducted at the Cleft Palate Center of the University Hospital of Nijmegen. Subjects The sample consisted of 26 boys with BCLP who were born between 1976 and 1990 and treated at the University Hospital of Nijmegen. Data for a control group of 34 noncleft boys were collected at the University Hospital of Amsterdam. Method Palatal arch dimensions were digitized on dental casts. A comparison between BCLP and noncleft dimensions was made at fixed time intervals. Results At birth, anterior and posterior arch widths as well as arch depths were significantly larger in children with BCLP. After 7 months (lip closure), anterior arch width and arch depth diminished considerably in the cleft group. After 12 months (palatoplasty), a slight decrease in posterior arch width was observed, and arch depths showed slight catch-up growth. At 4 years of age, anterior arch width was significantly narrower and anterior arch depth was shorter in children with BCLP than in control subjects. Posterior arch width was significantly wider. Conclusions During the first 4 years of life, maxillary arch dimensions in children with BCLP show a unique development that is significantly different from that in noncleft children.

Evaluation of the Clinical Effectiveness of Nasoalveolar Molding (NAM) Using Grayson Method Versus Computer-Aided Design NAM (CAD/NAM) in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial

2021 ◽  
pp. 105566562199015
Author(s):  
Noha A. El-Ashmawi ◽  
Mona M. Salah Fayed ◽  
Amr El-Beialy ◽  
Khaled H. Attia
Keyword(s):  
Computer Aided Design ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Comparative Trial ◽  
Clinical Effectiveness ◽  
3 Dimensional ◽  
Computer Aided ◽  
Aided Design ◽  
Nasoalveolar Molding ◽  
Maxillary Arch

Objective: The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer-aided design NAM (CAD/NAM) in patients with bilateral clefts. Design: The trial is a randomized comparative trial with 1:1 allocation ratio. Participants: Thirty infants with bilateral complete cleft lip and palate were recruited. Interventions: Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months. Main Outcomes: The primary outcome was to evaluate the changes in the intersegment cleft gap. Secondary outcomes included the analysis of the maxillary arch in transverse, anteroposterior, and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods. Results: Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99 mm (−3.79 to 0.19, P = .03) as compared to the NAM treatment. No differences were found between groups in the transverse and vertical maxillary arch changes. Conclusions: Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment.

Spontaneous Growth of the Palatal Plates in the Cleft Lip and Palate

2020 ◽  
pp. 105566562098278
Author(s):  
Felipe Pontes ◽  
Gabriella Callegaris ◽  
Renato da Silva Freitas
Keyword(s):  
Prospective Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Posterior Arch ◽  
Arch Width ◽  
A Prospective Study ◽  
3D Software ◽  
Nasoalveolar Molding ◽  
Plaster Models ◽  
Presurgical Orthopedics

Objective: This is a prospective study examining palatal casts from patients with unilateral cleft lip and palate (UCLP) in the first month of life, immediately before cheiloplasty, and immediately before palatoplasty. None of the patients receives presurgical orthopedics (nasoalveolar molding). Design: In this prospective study, upper arch plaster models were taken 3 times during the treatment: in the first month of life (T1), before the cheiloplasty (T2), and before the palatoplasty (T3). Anatomic landmarks were defined and linear anthropometric measurements were obtained afterward. Dimensional analysis was performed using 3D software. Two-way analysis of variance followed by Tukey test was performed for statistical analysis. Setting: Tertiary, institutional. Participants: Twelve patients with UCLP of either sex with less than 1 month of life and without any other syndrome. Intervention: No intervention was performed. Main Outcome Measure: Reduction of the cleft without using orthopedics apparatus. Results: There was a statistically significant reduction in the cleft gap comparing T1 to T3. There was also a significant reduction in the intercanine width comparing T2 and T3, and T1 and T3. There was significant increase in the posterior arch width comparing T2 and T3, and T1 and T3. The palatal plate’s width increased in all times analyzed. Conclusion: The palatal cleft narrows spontaneously as well in both midpoint and posterior point during the first 6 months of patient’s treatment. This event was enhanced by cheiloplasty. This surgery might have a greater influence on the anterior arch width than in the posterior arch region.

Longitudinal Study on the Changes of Maxillary Arch Dimensions in Japanese Children with Cleft Lip and/or Palate: Infancy to 4 Years of Age

1995 ◽  
Vol 32 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Yasuo Honda ◽  
Akira Suzuki ◽  
Masamichi Ohishi ◽  
Hideo Tashiro
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Lateral Displacement ◽  
Growth Patterns ◽  
Posterior Displacement ◽  
Arch Width ◽  
Dental Hospital ◽  
Growth Changes ◽  
Isolated Cleft Palate ◽  
Maxillary Arch

The focus of this study was an analysis of maxillary arch growth changes prior to the time of cheiloplasty up to 4 years of age. Serial dental casts were obtained and measured in 95 children with cleft lip and palate, or both: 7 unilateral cleft lip and alveolus (CLA), 52 unilateral cleft lip and palate (UCLP), 24 bilateral cleft lip and palate (BCLP), and 12 isolated cleft palate (CP). The children were treated at the Kyushu University Dental Hospital. The results are as follows: (1) Prior to cheiloplasty, the maxillary buccal segments in the subjects with cleft lip and palate showed lateral displacement. The premaxilla in BCLP subjects was protruded. (2) Cheiloplasty influenced maxillary anterior arch width, but not posterior width. The operation caused posterior displacement of the premaxilla in BCLP subjects. (3) Palatoplasty affected the growth of the maxillary arch in the transverse and anteroposterior dimensions. (4) A variety of growth patterns observed in the patients (e.g., increasing or decreasing of the maxillary arch dimensions) suggests that maxillary arch dimensions were affected not only by surgery, but also by other individual factors such as genetic facial pattern and severity of the cleft.

OrthoAligner “NAM”: A Case Series of Presurgical Infant Orthopedics (PSIO) Using Clear Aligners

2019 ◽  
Vol 57 (5) ◽  
pp. 646-655 ◽  
Author(s):  
Puneet Batra ◽  
Bruno Frazāo Gribel ◽  
B. A. Abhinav ◽  
Anika Arora ◽  
Sreevatsan Raghavan
Keyword(s):  
Treatment Planning ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Series ◽  
3 Dimensional ◽  
The Past ◽  
Belo Horizonte ◽  
Infant Orthopedics

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.

scholarly journals Three-Dimensional Soft Tissue Nasal Changes After Nasoalveolar Molding and Primary Cheilorhinoplasty in Infants With Unilateral Cleft Lip and Palate

2018 ◽  
Vol 56 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Laura Mancini ◽  
Travis L. Gibson ◽  
Barry H. Grayson ◽  
Roberto L. Flores ◽  
David Staffenberg ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Case Series ◽  
Midsagittal Plane ◽  
Retrospective Case ◽  
Anthropometric Measures ◽  
Nasal Tip ◽  
Nasoalveolar Molding ◽  
Nasal Changes

Objective: To quantify 3-dimensional (3D) nasal changes in infants with unilateral cleft lip with or without cleft palate (UCL±P) treated by nasoalveolar molding (NAM) and cheilorhinoplasty and compare to noncleft controls. Design: Retrospective case series of infants treated with NAM and primary cheilorhinoplasty between September, 2012 and July, 2016. Infants were included if they had digital stereophotogrammetric records at initial presentation (T1), completion of NAM (T2), and following primary cheilorhinoplasty (T3). Images were oriented in 3dMD Vultus software, and 16 nasolabial points identified. Patients: Twenty consecutively treated infants with UCL±P. Interventions: Nasoalveolar molding and primary cheilorhinoplasty. Main Outcome Measures: Anthropometric measures of nasal symmetry and morphology were compared in the treatment group between time points using paired Student t tests. Postsurgical nasal morphology was compared to noncleft controls. Results: Nasal tip protrusion increased, and at T3 was 2.64 mm greater than noncleft controls. Nasal base width decreased on the cleft side by 4.01 mm after NAM and by 6.73 mm after cheilorhinoplasty. Columellar length of the noncleft to cleft side decreased from 2:1 to 1:1 following NAM. Significant improvements in subnasale, columella, and nasal tip deviations from midsagittal plane were observed. Treatment improved symmetry of the alar morphology angle and the nasal base–columella angle between cleft and noncleft sides. Conclusions: Three-dimensional analysis of UCL±P patients demonstrated significant improvements in nasal projection, columella length, nasal symmetry, and nasal width. Compared to noncleft controls, nasal form was generally corrected, with overcorrection of nasal tip projection, columella angle, and outer nasal widths.

Maxillary Dental Arch Affected by Different Sleep Positions in Unilateral Complete Cleft Lip and Palate Infants

1994 ◽  
Vol 31 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Chiung-Shing Huang ◽  
Hsin-Chung Cheng ◽  
Yu-Ray Chen ◽  
M. Samuel Noordhoff
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Longitudinal Change ◽  
Sleep Position ◽  
Dental Arch ◽  
Initial Visit ◽  
Arch Width ◽  
Supine Sleep ◽  
The Relationship ◽  
Maxillary Arch

The development of the dental arch is well designed for adaptive and compensatory growth. In this study, the relationship between the sleep position and dental arch development was Investigated. A group of 42 infants with unilateral complete cleft lip and palate with either prone (16) or supine (26) sleep position were seen in the craniofacial center. All infants were less than 1 month of age at the initial visit. Dental impressions of the maxillary arch were taken at the initial visit and just before cheiloplasty. Ten arch dimensions were measured in each dental cast and the longitudinal change in each dimension was compared between the prone sleep group and the supine sleep group. Statistically significant changes were detected in the growth rate of the following dimensions: intercanine width, intertuberosity width, alveolar cleft width, anterior cleft width, and posterior cleft width. This study indicated that sleep position affected maxillary arch development. Infants sleeping in the prone sleep position tended to have narrower arch width and cleft width.

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