Presurgical Nasoalveolar Moulding In Neonate With Unilateral Cleft Lip And Palate; As An Early Rehabilitative Procedure

Abstract

Management of a neonate with cleft lip and palate and assuring the parents regarding the future well being of the child can be a challenging task. referral by pediatrician and treatment by an Orthodontist and a Plastic Surgeon can help in limiting the deformity to its minimum and aid in normal growth and development of the child. This paper describes the treatment of two neonates with unilateral cleft lip and palate whose treatment were initiated within 24 hours of their birth. Presurgical Nasoalveolar Moulding(PNAM) followed by one stage surgical repair of lip helped us to achieve remarkable results. Keywords: Lip taping, nasal stent, Presurgical nasoalveolar moulding, presurgical orthodontics and orthopaedics, PNAM. I. Introduction Pruzansky was once asked, When should an Orthodontist's, speech pathologist's, Prosthodontist's intrest in the cleft palate child begin? His response: Everyone who seeks to serve the needs of the child with a cleft should begin at the beginning. The present case report followed the same concept of Timely initiation of PNAM that gave the excellent results.(1) Cleft lip and palate (CLP) can present with considerable variation in severity and form. Generally the wider, more extensive clefts are associated with more significant nasolabial deformity. These clefts deficient in both hard and soft tissue elements, present a significant surgical challenge to the achievement of a functional and cosmetic outcome.The global epidemiological survey states that cleft palate is present in one in every 600 newborns. United States Bureau of Census (2001) says that a child with cleft is born every 2.5min. Incidence is highest among Asians followed by Caucasians and Africans. In India over 3,500 cleft lip and palate per year are reported.(2) The Cleft lip and palate(CLP) is associated with constellation of problems that need to be solved for successful rehabilitation.(3,4) The integration of Pediatrician, Plastic surgeon, Orthodontist, Oral surgeon, Pedodontist, Prosthodontist, Speech Therapist, Genetic Scientist, Social Worker and Psychiatrist is needed for the management of CLP from birth to till complete rehabilitation is achieved. ( 5 ) The cases reported here shows the remarkable outcome as a result of timely referral from Pediatrician to Plastic surgeon and Orthodontist to bring about optimal results of Presurgical Nasoalveolar Moulding (PNAM) and primary lip surgery in UCLP neonates.