Presurgical Nasoalveolar Molding Therapy Research Articles

Knowledge, Attitude, and Perception among Dental Graduate Practitioners about Presurgical Naso-alveolar Molding Therapy in cleft lip/palate infants: A Questionnaire-based Survey

Aim: To explore or evaluate dentist’s (BDS graduate practitioners) knowledge and perception towards Presurgical Naso-alveolar molding (PNAM) in cleft lip/palate infants. Materials and methods: A questionnaire containing 10 validated questions (Google forms) was electronically distributed through E-mail and WhatsApp. A total of 144 BDS graduate practitioners were included in the study. The data obtained was subjected to statistical analysis. Results: The majority of BDS practitioners were not aware of PSNAM regarding many of its aspects like the time duration required for PSNAM treatment, the person who performs PSNAM, the design of the appliance, and the infant's age at which it is carried out. 91% of the practitioners showed interest in learning information about PSNAM and wished to attend workshops or courses about PSNAM. Conclusion: There is a necessity to enhance the level of awareness, perception, and knowledge of BDS graduate practitioners towards the PNAM treatment performed in cleft lip/palate infants.

Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study.

This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP). Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups. In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm. Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height.

Virtual Reality as parent education tool in pre-surgical management of cleft lip and palate affected infants-A pilot study.

To assess the influence of virtual reality (VR) in parent acceptance of the pre-surgical nasoalveolar molding (PNAM) as a pre surgical care to the cleft lip and palate affected infants. Descriptive Cross sectional pilot study design was planned to assess the pre surgical management of the cleft lip and palate. Twenty parents/caregivers of the infants were randomly divided into two groups. Twelve participants received education through conventional education module (Group I) using verbal explanation supported by the photographs. Another 12 participants received education through customized VR based educational video (Group II). After the education, the parents were provided with questionnaire to assess the acceptance of the treatment procedure. The survey response rate was represented in percentage. The results of the study indicated that most of the parents were aware of the feeding plate or obturators as an aid in assisting feeding practices among cleft lip and palate affected infants. However, only 33% of participants in Group I were able to understand the doctor's explanation regarding the PNAM whereas 100% of participants in Group II were able to visualize the benefits of PNAM. These participants were willingly accepting PNAM as essential pre-surgical care. Innovative approaches are essential in patient education modalities as the success of any treatment outcome largely depends on the patient acceptance. Within the limits of this study, VR has been successful in the educating the parents and caregivers regarding the acceptance of PNAM therapy in cleft affected infants.

Correction of Unilateral Cleft Lip, Palate and Alveolus by Presurgical Nasoalveolar Molding using Modified Nasal Stent- A Case Report

Cleft deformities may lead to psychological problems, dental problems, and aesthetic problems, if left untreated. Hence the management of cleft patients is quite challenging and controversial which involves a multidisciplinary approach including members of various specialties. The Presurgical Nasoalveolar Molding (PNAM) method is an innovative therapy for mitigating the impact of craniofacial deformities. The use of PNAM therapy in a newborn infant is described in this case report. Impressions were taken during the first visit and on the same day lip tape therapy (lip taping) was started using 3M™ Steri Strip™. The Nasoalveolar Molding (NAM) plate was delivered to approximate the cleft alveolus. A modified nasal stent appliance was administered until the cleft gap was decreased to around 4 mm and the cleft lip was repaired through surgery. The use of PNAM with the modified nasal stent appliance showed promise in lowering the amount of the cleft deformity of the lip, palate, and alveolus, with improving nasal aesthetics. When comparing pre-NAM to post-NAM, there was also a considerable reduction in the alveolar defect. In cleft patients, the PNAM-assisted primary reconstruction employing a nasal stent appliance resulted in an overall improvement of the nasolabial complex, enhanced aesthetics, and a reduction in the extent of surgery and surgical operations.

Effect of Cleft Width on the Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate.

The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.

Presurgical Nasoalveolar Molding Therapy in Bilateral Cleft Lip and Palate – A Case Report

Presurgical Nasoalveolar Molding Therapy in Bilateral Cleft Lip and Palate – A Case Report

Novel Three-Dimensional Coordinate System to Analyze Alveolar Molding Effects of Pre-Surgical Nasoalveolar Molding on Infants With Non-Syndromic Unilateral Cleft Lip and Palate.

The aim of this study is to establish a stable 3-dimensional (3D) coordinate system for investigating the alveolar molding effects of pre-surgical nasoalveolar molding (PNAM) on non-syndromic unilateral cleft lip and palate (UCLP) patients, basing on the Frankfort Horizontal (FH) plane.Twenty-one non-syndromic UCLP neonates who sought medical advice in the department of Orthodontics, from 2016.5 to 2017.10 were enrolled in the present study. All neonates were subjected to PNAM before the cleft lip repair. The treatment duration was 75.76 days. Silicone rubber models were obtained and scanned using a 3D laser scanner pre- and post-PNAM treatment. A 3D coordinate system based on the FH reference plane was built utilizing Rhino3D software to record the landmark 3D coordinates, to measure the distance, angle, and length variables. The Paired Student's t test and the Pearson correlation coefficient were used to calculate reproducibility and reliability of the landmark localization for repeated measurements. Changes of the measurement variables were analyzed by the Paired Student's t test.This study revealed a high reproducibility and reliability for most of the landmarks. By the end of PNAM treatment, the cleft gap was reduced with the malformation of alveolar segments aligned normally and the anterior points of both alveolar segments were rotated to the cleft side.Utilizing the FH plane to set up a rigorous and stable 3D system is meaningful. PNAM therapy is effective in reducing the severity of the maxillary deformity not only on the non-cleft side, but also on the cleft side.

Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability.

To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. Prospective clinical trial. Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.

Dynamic changes in nasal symmetry after presurgical nasoalveolar molding in infants with complete unilateral cleft lip and palate.

Background:Presurgical nasoalveolar molding (PNAM) technique gave a new perspective to presurgical infant orthopedics. Nasal reconstruction presents a challenge for the plastic surgeons in case of patients with unilateral cleft lip and palate (UCLP). PNAM facilitates the reshaping of the nasal cartilage and molding of maxillary arch preoperatively. This therapy not only aids the surgical repair of lip but also enhances the overall postsurgical results with negligible postoperative scar.Aim:The aim of the study was to analyze nasal changes before and after PNAM in patients with complete UCLP.Materials and Methods:This was a retrospective review of 22 ULCP patients who underwent PNAM before lip surgeries. A series of standard basilar view photographs in 1:1 ratio were taken, and linear measurements were done directly on the photographs.Results:After PNAM therapy, there was highly significant increase in the nostril height, nostril dome height, and columella length (P < 0.001*) and highly significant reduction in the nostril width and nasal basal width (P < 0.001*).Conclusion:Significant improvement in the nasal symmetry was found after PNAM therapy in patients with complete UCLP.

Achievement in Nasal Symmetry after Cheiloplasty in Unilateral Cleft Lip and Palate Infants Treated with Presurgical Nasoalveolar Molding.

Background:The presurgical nasoalveolar molding (PNAM) technique gave a new perspective to presurgical infant orthopedics. Nasal reconstruction presents a challenge for the treating surgeons in case of patients with unilateral cleft lip and palate (UCLP). PNAM facilitates the reshaping of the nasal cartilage and molding of maxillary arch preoperatively.Aims and Objective:The aim and objective of the present retrospective study was to analyze two-dimensional nasal changes before and after PNAM in patients with complete UCLP.Materials and Method:Twenty-two ULCP patients who underwent PNAM before lip surgery were considered in this study. A series of standard basilar view photographs in 1:1 ratio were taken and linear measurements were done digitally.Results:After PNAM therapy, there was a significant increase in nostril height (P = 0.003) and highly significant increase in columella length (P = 0.001). There was also a highly significant decrease in nostril width (P = 0.001) and a significant decrease in nasal basal width (P = 0.02).Conclusion:There was a significant increase in nostril height and columella length and a significant decrease in nostril width and nasal basal width on the cleft side when treated with PNAM therapy in patients with complete UCLP. Hence, this therapy helps in improving the nasal symmetry in such patients and also aids in surgical procedures.

Presurgical Nasoalveolar Molding Therapy Using Figueroa's NAM Technique in Unilateral Cleft Lip and Palate Patients: A Preliminary Study.

The objective of the study was to evaluate the results of nasoalveolar molding (NAM) in the treatment of patients with unilateral cleft lip and palate using a modified technique in a South Indian population. The design was a prospective study with blinded measurements. The sample constituted 10 complete unilateral cleft lip and palate (UCLP) patients who underwent NAM therapy by the same operator. Direct extra and intra oral anthropometric measurements were done using a digital vernier caliper before and after NAM therapy. A photographic evaluation was also done to rate the nasal deformity post NAM therapy. The differences between measurements were statistically analyzed using paired t tests. The extra oral measurements revealed a statistically significant increase in bi-alar width, columellar length and width. The intraoral measurements demonstrated a statistically significant reduction in anterior alveolar cleft width. There was also a significant increase in arch width and greater and lesser segments length. All cases were rated as improved by the surgeons in photographic analysis. The study has quantitatively shown that the modified NAM therapy improved nasal asymmetry by columellar lengthening and effectively molded the maxillary alveolar arch.

Effects of nasoalveolar molding therapy on alveolar morphology in unilateral cleft lip and palate using two different approaches

Objective: The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy by standard Grayson technique (G1) and Yen Modification single step NAM technique (G2) on alveolar tissues in patients with unilateral cleft lip and palate (UCLP) using three-dimensional digital models. Materials and Methods: Totally, 10 patients with a mean age of 20 ± 16.07 days, having complete UCLP, were included in this prospective study. The maxillary plaster models were scanned. The study sample was divided into two group of 5 UCLP patients (G1 treated by standard Grayson technique and G2 treated by Yen Modification) for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured on the maxillary casts, and the distance and area measurements were performed using software Poly works (IIT Delhi). All subjects had undergone PNAM therapy for 3 months, the alveolar segments should have been approximated (≤5 mm), and the cleft width after PNAM should be reduced. Results: The decrease of the cleft width and arch length on the cleft side were significantly altered on the affected side (P < 0.005). No significant changes were observed when comparing both the groups using standard Grayson technique and Yen Modification single step NAM technique (G1 and G2). Conclusion: PNAM therapy effects mainly in the anterior alveolar segment and reduction of palatal and alveolar cleft width in patients with unilateral clefts of lip, alveolus, and palate in both Grayson and Yen Modification single step NAM technique. Both the Groups G1 and G2 suggested same treatment outcome in term of alveolar molding, but single step technique reduces patient's visits.

Use of Elastic Tapes in Presurgical Nasoalveolar Molding: A Case Report

ABSTRACT Objective: One of the objectives of presurgical nasoalveolar molding (PNAM) is to bring the lips together in order to decrease the severity of the deformity before surgery. This case report aims to present PNAM therapy of an infant with bilateral cleft lip and primary palate using prefabricated elastic tapes. Materials and Method: A 3-day-old baby girl with bilateral cleft lip and alveolus was referred to our clinic. Her extraoral examination revealed a deviated and protruded premaxilla, a deficient columella, a short prolabium, depressed alar cartilages, and separated lip segments. A PNAM appliance combined with dynamic tapes (DynaCleft, Canica Design Inc, Ontario, Canada) was delivered the same day. Results: After 3 months of PNAM therapy the premaxillary deviation was corrected, the columella and prolabium were lengthened, and projection and symmetry of the nose were obtained. The horizontal elastic tapes decreased the muscle tension and brought the lips together. Conclusion: Dynamic bands are...

Presurgical Nasoalveolar Molding (PNAM) for a Unilateral Cleft Lip and Palate: A Clinical Report

Cleft lip and palate deformity is a congenital defect of the middle third of the face. Incidence varies from 1:500 to 1:2500 live births. Etiology depends upon hereditary and environmental factors. Restoration of these defects is important not only for functional and esthetic reasons, but also because there may be a positive psychological impact for the patient and parents. The goal of primary closure of the lip for unilateral cleft lip is to ensure a normal and symmetrical lip and nose. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar molding (PNAM) represents a paradigm shift from the traditional methods of presurgical infant orthopedics. PNAM consists of active molding of the alveolar segments as well as the surrounding soft tissues. This clinical report describes a new approach of PNAM therapy for an infant with complete unilateral cleft lip and palate showing significant reduction in cleft defect size and improved contour and topography of deformed surrounding soft tissues.

Is Presurgical Nasoalveolar Molding Therapy More Effective in Unilateral or Bilateral Cleft Lip–Cleft Palate Patients?

The purpose of this study was to compare the efficacy of presurgical nasoalveolar molding in treating unilateral versus bilateral cleft lip–cleft palate patients. A blinded, retrospective study was conducted with 16 unilateral and 13 bilateral cleft lip–cleft palate patients. Pretreatment and posttreatment facial and intraoral impressions were used to compare soft- and hard-tissue changes. Nasoalveolar molding therapy improves nasal angle in unilateral (p = 0.010) and bilateral cleft lip–cleft palate (p = 0.001) patients, and improves nostril width in unilateral (p = 0.005) and bilateral cleft lip–cleft palate (p = 0.028) patients. Treatment significantly improves nostril breadth only in unilateral cleft lip–cleft palate patients (p = 0.005). Compared with bilateral cleft lip–cleft palate patients, unilaterally affected patients were more asymmetric before and after nasoalveolar molding therapy. Nasoalveolar molding more effectively increases columellar height (p = 0.002) and columellar width (p = 0.002) in the bilateral cleft lip–cleft palate group. Although starting bialar widths did not significantly differ between the two groups, nasoalveolar molding significantly decreased bialar width only in unilateral cleft lip–cleft palate patients (p = 0.032). When the intersegment alveolar cleft distances of the bilateral cleft lip–cleft palate patients were summed, an improvement similar to that in unilateral cleft lip–cleft palate patients was observed. Furthermore, nasoalveolar molding appeared to prevent alveolar width widening as patients continued to grow. There are differences in efficacy between unilateral and bilateral cleft lip–cleft palate patients undergoing nasoalveolar molding. Understanding these differences may help physicians and dentists better shape expectations.

Long-Term Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate

The purpose of this study was to evaluate the long-term effectiveness of presurgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip and palate (UCLP). Twenty-five patients with UCLP treated by either PNAM or non-PNAM therapy between 1998 and 2003 were recruited in the study. During the clinical examination and data analysis, the evaluators were blinded to which patients received PNAM. The patients were reviewed clinically, and their facial morphology was captured with a three-dimensional scanner. Their dental arch configuration and occlusion were recorded by plaster dental models. After the patient evaluations and measurements were completed, the patient list was unblinded. There were 20 patients in the PNAM group and 5 patients in the non-PNAM group. Fisher exact tests and Wilcoxon rank sum tests were used to compare the outcomes. Clinically, the improvement in the PNAM group was most evident in nasal and lip anatomy. However, there were no statistically significant differences between the 2 groups on each of the measurements on three-dimensional facial images and dental models. Our study suggests a trend toward a long-term clinical improvement in nasal and lip anatomy of UCLP patients treated with PNAM. However, these improved results were not confirmed by three-dimensional stereophotography. There was no statistically significant difference in the long-term three-dimensional anthropometric measurements and dental model analysis between the PNAM group and the non-PNAM group.

Effects of Nasoalveolar Molding Therapy on Nasal and Alveolar Morphology in Unilateral Cleft Lip and Palate

The objective of this study was to evaluate the effects of presurgical nasoalveolar molding (PNAM) therapy on nasal and alveolar tissues in patients with unilateral cleft lip and palate. Twenty-two patients with a mean age of 23 days, having complete unilateral cleft lip and palate, were included in this prospective study. After the impressions were taken of the palatal and nasolabial regions separately, the maxillary and nasal plaster models were scanned for linear, angular, and area measurements before and after PNAM therapy. The distances between the identified landmarks were measured in the maxillary casts, and the distance and area measurements were performed for the nasal casts with the specified software called Image J developed by the National Institutes of Health. All subjects have undergone PNAM therapy for 6 months. The nasal and maxillary casts are scanned, and the images were evaluated using the software Image J. The alveolar segments should be approximated, and the cleft width and alar base of the affected side after PNAM should be reduced, and the nostril area of the cleft side should be increased. The columella deviation should be decreased. The decrease of the cleft width, arch length, and alar base width on the cleft side and the deviation of the columella were significant, in addition to the significant increase of the arch circumference and nostril area on the affected side (P < 0.001). Presurgical nasoalveolar molding therapy is a significantly helpful treatment for patients with unilateral cleft lip and palate. The reduction in the alveolar cleft region and the nasal reshaping are favorable.

Complications and Solutions in Presurgical Nasoalveolar Molding Therapy

To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n = 12) and the Medical College of Georgia (n = 15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.

Presurgical Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate: A Preliminary Study

Presurgical Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate: A Preliminary Study

Presurgical Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate: A Preliminary Study

To evaluate the outcome of presurgical nasoalveolar molding (PNAM) therapy in the treatment of patients with nonsyndromic unilateral cleft and palate (UCLP). A prospective study with blinded measurements. Twelve patients with UCLP treated from 1997 to 2003. The starting age for PNAM therapy was 26 days and the average length of the therapy was 110 days. Measurements of intraoral and extraoral casts were made, and statistical analyses were used to compare the differences between pre- and posttherapy measurements. After PNAM therapy, there was a statistically significant decrease in both intersegment alveolar cleft distance and columellar deviation (p < .05). There was also a statistically significant increase in cleft nostril height, maxillary width, and columellar width (p < .05). Moreover, although there was no statistically significant reduction of the affected nostril width, it demonstrated on average 1.7-mm reduction after PNAM therapy. The length of the time the patient utilized the appliance and postmolding nostril height were found to have a statistically significant positive correlation (p < .05). PNAM therapy decreases intersegment alveolar cleft distance while permitting an increase in posterior maxillary arch width. It also increases nasal symmetry by decreasing columellar deviation, increasing nostril height on the affected side, maintaining bialar width of nose, increasing columellar width, and creating more symmetrical nostril heights and widths. The improvement of the height of the cleft nostril was correlated with the time the appliance was applied.