Dynamic Molding of Cleft Nasal Cartilage in Unilateral Complete Cleft Lip and Palate Using Simple Segmented NAM.

Abstract

Nasal morphology remodeling by nasoalveolar molding (NAM) before primary lip repair gives better post-surgery outcomes. However, traditional NAM has high technical sensitivity, a steep learning curve, frequent need for modifications, and interrupts lifting forces on the nasal cartilage during oral movements, thereby reducing overall efficacy of device. To eliminate interaction and interdependency of the nasal bulb with alveolar molding plate, we propose segmenting NAM (SNAM) into nasolabial complex molding (NCM) and alveolar complex molding (ACM). NCM addresses ala-septum, lip-premaxilla via lambda-nasal hook and lip taping. ACM addresses palate-alveolus via Yen-modified feeding plate. When the hook is suspended by elastic traction, nasal complex undergoes a natural rotation, where cleft-side ala lifts and septum medializes. Lip taping and feeding plate augment positive molding of cleft segments and maintain transverse relation. The current study outlines SNAM treatment strategy and assesses the effect on nasal deformity. Retrospective observational cohort study set in a comprehensive cleft care centre. Twenty patients with unilateral complete cleft lip and palate who underwent SNAM were selected. Retrospectively, standardized basilar views, pre-, and post-SNAM therapy were evaluated for nostril height, and nostril width, as a ratio of cleft to non-cleft side along with columellar deviation angle. SNAM resulted in significantly improved nostril symmetry with no complications observed. Nostril height ratio increased from 0.35 ± 0.10 to 0.78 ± 0.17. Nostril width ratio decreased from 3.14 ± 0.66 to 2.18 ± 0.42. Columellar deviation angle increased from 26.5 ± 6.30 to 58.5 ± 9.88 degrees. Dynamic correction of the nasal deformity in UCLP is possible through SNAM therapy.