A Modified Naso-Alveolar Molding Device for Unilateral Cleft Lip and Palate

Abstract

Objective: Naso-alveolar-molding(NAM) is used to reshape the nasal cartilage and mold the maxillary alveolar arch before surgical cleft/lip repair. The study aimed to modify the conventional-NAM-device to lessen the severity of cleft lip/palate deformity and make the overall procedure simpler and beneficial, with fewer hospital recall visits.Methods: Sixty-six patients with unilateral cleft lip/palate were selected: 21 males and 12 females were fitted with a conventional-NAM-device, whereas 18 males and15 females were fitted with a modified-NAM-device. The inter-alveolar gap ranged between (14.5 and 13.5)mm. A presurgical-NAM-device was applied in the second week after the birth. Standardized parameters of cleft lip/palate were measured on the cast. Nostril width, columellar height, and columellar angle were measured on photographs. The number of recall visits was recorded. The modified device was similar to the conventional-NAM-device. However, the nasal stent was made of acrylic and separated from the plate. The thickness of the acrylic stent ranged from 10 to 3mm. The thicker and heavier acrylic was placed on the bigger arch side, and the thin part was placed on the small arch side.Results: A difference was observed between the conventional and modified device in the time taken to reduce the inter-alveolar-gap. Additionally, with the modified device there were fewer recall visits to the hospital. Furthermore, when the conventional NAM was compared with the modified device, the latter showed a significant improvement regarding the patients’ outcome (One-way-ANOVA or Kruskal-Wallis).Conclusions: The modified device is an effective and non-invasive device for accelerating the alignment of the alveolar segments to create the foundation upon which excellent lip/primary nasal surgery results can be achieved. This modification made the procedure more beneficial and simpler for the patient and parents. At the same time, recall visits were reduced by half when compared to those required for the conventional device.