Surgical Assistance for Favorable Outcome Achieved through Presurgical Nasoalveolar Molding Using Innovative Impression Technique: A Case Report.

Abstract

The aim of this case report is to highlight the importance of presurgical nasoalveolar molding (PNAM) in cleft lip and palate (CLP) cases and its impact on primary surgical outcomes. Cleft lip and palate (CLP) is one of the most common congenital malformations of the maxillofacial complex. Of all congenital malformations, it ranks third and has a multifactorial etiology. Such anomalies can have several consequences, such as impaired suckling, defective speech, deafness, malocclusion, gross facial deformity, and bring tremendous stress on the entire family. Surgical correction is required to restore the form and function of the affected area; however, surgery has to be usually deferred due to the age of the newborn patients. A 12-day-old neonate born with a bilateral cleft of lip and alveolus was referred from the Department of Plastic Surgery. PNAM was planned in consultation with the plastic surgeon. A customized nasoalveolar molding plate was fabricated, and tissue molding was carried out. Following nasoalveolar molding, primary surgical repair was done. Significant reduction in cleft width, approximation of soft tissue of the lip, and improvement in nasal tip alignment were achieved following PNAM. It favorably positioned the tissue segment and minimized the extent of the local tissue dissection and advancement. The synchronous prosthodontics and surgical treatment resulted in optimal treatment outcomes. The higher level of estrogen and hyaluronic acid in the newborn that remodels the cartilage can be utilized through the light application of forces, and hence hard and soft tissue molding can be achieved without surgery. PNAM acts as a promising adjunct prior to primary surgical closure of the CLP. Thus, PNAM immediately after the birth can serve to significantly augment the surgical outcomes and the extent and/or the number of surgeries can be reduced. Rathee M, Singh K, Alam M, et al. Surgical Assistance for Favorable Outcome Achieved through Presurgical Nasoalveolar Molding Using Innovative Impression Technique: A Case Report. Int J Clin Pediatr Dent 2023;16(1):153-158.