Active nasoalveolar molding using 3-directional expansion screw for arch alignment in bilateral cleft lip and palate

Abstract

• A 3-D expansion screw can retract protrusive premaxilla and expand cleft arches simultaneously. • This facilitates quick premaxillary distalization in newborn with bilateral cleft lip and palate. • A separate nasal stent can thus be given early corresponding to period of increased estrogen levels. The alignment of cleft segments is the primary step in presurgical orthopedics and is more critical in the bilateral clefts, in which the arch is segmented into 3 units. The projecting premaxilla poses a great challenge to the alignment of the segmented arch because of its unrestrained forward movement. The lateral segments are often collapsed with anterior narrowing. This results in great difficulty in correctly positioning the premaxillary segment during primary cheiloplasty as there is inadequate space available to align the anterior segment between the collapsed lateral segments. The current report suggests active nasoalveolar molding using a 3-directional expansion screw for simultaneous retraction of the anterior segment and the expansion of the lateral cleft segment to provide adequate space between them to receive the retracted segment. The nasal stent can be given as a separate entity very early in the treatment as the obscuring premaxilla is quickly retracted to allow for nasal stent attachment to the alae. Thus, nasal correction can be initiated early and independently from oral corrections. A 3-dimensional model superimposition revealed retraction of 2.8 mm of the premaxilla and 3.8 mm expansion during a treatment period of 3 months. The cleft defect was reduced by 4.8 mm on the right side and 10.2 mm on the left side, with all 3 cleft segments in good alignment. Good columellar elongation was achieved with satisfactory nasal contour and symmetry.