A new approach in Presurgical Infant Orthopedics using an Active Alveolar Molding Appliance in the management of bilateral cleft lip and palate patient: A Case Report

Abstract

Cleft lip and palate can arise with considerable variation in severity and form. Generally, the wider, more extensive clefts are associated with more significant nasolabial deformity. These clefts, deficient in hard and soft tissue elements, present a significant surgical challenge to achieve a functional and cosmetic outcome. A finer scar forms when a surgical incision heals under less rather than more tension. The principal objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. The nasoalveolar molding appliance is a modern presurgical orthopedic device that allows for a positive growth of the alveolar ridges into an improved arch form as well as reshaping of the flattened nose into a more symmetrical shape. As a result of the presurgical appliance, the nose and lip are allowed to heal under minimal tension, thereby reducing scar formation and improving the esthetic result. This case report describes the management of a bilateral cleft lip and palate case with the use of an active alveolar molding appliance which retracts the forwardly placed premaxilla into a more esthetic position prior to the primary surgical repair.