Presurgical Nasoalveolar Molding Research Articles

Effect of NAM on Nasal Symmetry and Proportions in Patients with UCLP: A Systematic Review

Introduction : Nasal reconstruction presents a challenge in case of patients with unilateral cleft lip and palate (UCLP). Correction of the nasal deformity to achieve a symmetrical nose from the deficient columella and malformed nasal cartilage in cleft patients presents a great challenge. Nasoalveolar molding (NAM) was developed as a neoadjuvant therapy for patients with cleft lip and palate to improve nasal deformity before surgical intervention. The aim of this systematic review was to understand more about the effect of NAM on nasal symmetry and proportions in patients with UCLP. Method : We searched for manuscripts involving patients with UCLP who received NAM prior to cleft lip repair. Electronic literature searching of the PubMed, Scopus, Cochrane and Google scholar databases was conducted for the studies that had been published up to December 2021. Result : Presurgical NAM demonstrated benefits in nasolabial form when compared with patients who did not receive any presurgical infant orthopaedic appliances (PSIO). The use of presurgical NAM helps to achieve favourable reshaping of the nose and decrease the severity of the initial cleft deformity, resulting in improvement on nasolabial form. These changes lead to improved nasal symmetry and proportions in UCLP patients. Conclusion: The preponderance of evidence in this review suggests that presurgical NAM is a beneficial adjuvant therapy for nasal deformity correction and helps achieve nasal symmetry in patients with UCLP. However, there is insufficient evidence to conclude whether presurgical NAM produces these benefits at the time of nasal maturity.

An investigation into nutritional methods at the fifth day after birth of infants in association with cleft type and laterality.

In patients with clefts, the affection of other congenital malformations on the feeding is unclear. We investigated the other congenital malformations and nutritional intake of neonates with cleft lip and/or palate and examined their relationships associated with cleft type and laterality. The participants included 126 infants under treatment with a presurgical naso-alveolar molding (PNAM) or a Hotz-type plate. The survey items were gender, cleft type and side, presence and nature of other congenital malformations, birth weight and nutritional method at age of the fifth day. The number of infants was 36 (28.6%) of cleft lip and alveolus, 82 (65.1%) of cleft lip and palate, and 8 (6.3%) of cleft palate only. Forty-three patients (34.1%) had other various congenital malformations. The nutritional method included oral intake in 78.6% (n=99) of cases and tube feeding with/without oral intake in 21.4% (n=27) of cases. The rate of tube feeding was higher for right-sided clefts than that for left-sided clefts. This observation was consistent with the fact that right-sided clefts were associated with more significant other congenital malformations than those on the left-side. The nutritional method for infants with cleft lip and/or palate was related to the presence of other congenital malformations, not to cleft laterality or oral cleft itself under early treatment with PNAM plate. These results proposed that screening the general condition is essential for neonates with right-sided cleft lip with/without cleft palate compared to left-sided clefts, which should be conducted immediately after birth for planning the appropriate nutritional method.

Influence of presurgical nasoalveolar molding (PNAM) treatment in maxillary dental arch width and nasolabial symmetry in patients with unilateral complete cleft lip and palate.

Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subphenotypes among nonsyndromic cleft lip and/or palate (NSCL/P), that complicates surgical repair operations. Presurgical nasoalveolar molding (PNAM) is a technique used to reshape the nose, lip and alveolar bone of infants with UCCLP before surgery (the modified Mohler rotation advancement cheiloplasty and two flap palatoplasty), with the potential to facilitate surgical repair. However, the effectiveness of PNAM treatment is still a matter of debate. In this paper, the 3Shape scanning system and 3dMD stereophotography were used to assess the short-term and long-term effects of PNAM treatment on the dental arch morphology and nasolabial features of patients with UCCLP, respectively. The findings indicated that PNAM treatment negatively affects both short-term and long-term dental arch shape compared to the treatment without PNAM, particularly in terms of limiting the transverse width of the maxillary canine-to-midline. Regarding the nasal and labial symmetry, PNAM improves the symmetry of the nasal alae in patients over 7 years old and the symmetry of the lip in patients under 7 years old. Moreover, UCCLP patients who received PNAM treatment exhibited a shorter and wider shape of the nostril on the cleft side compared to those without PNAM treatment. In clinical practice, the multidisciplinary team should carefully consider the advantages and disadvantages of the outcomes of PNAM treatment when treating infants with cleft lip and palate.

Presurgical Nasoalveolar Molding—Efficacy and Biomechanics in Management of Cleft Lip and Palate: A Review of the Literature

AbstractPresurgical infant orthopaedics (PSIO) appliances are used in the management of cleft lip and palate. Frequently, among all PSIO appliances utilized is presurgical nasoalveolar molding (NAM) appliance. In this review, we looked for the application of the NAM appliance, its efficacy, and biomechanics. A comprehensive search strategy was performed in two databases (Google Scholar and PubMed) for articles using NAM in the treatment plan of patients with cleft lip and palate. Six articles were included in this study with one randomized control trial, two retrospective, and three case reports studies. The studies reveal the NAM is efficient as a presurgical modality treatment for complete cleft lip and palate with multiple benefits, including reducing surgical scars and alveolar gap, used as feeding plate, improve nasal contour, and decreased the number of rectifying surgical procedure.

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.

Efficacy of Postsurgical Nostril Retainer in Patients with Unilateral Cleft Lip and Palate Treated with Presurgical Nasoalveolar Molding and Primary Cheiloplasty-Rhinoplasty.

The aim of this investigation was to determine whether the nasal form of patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding therapy, primary lip-nose surgery, and postsurgical nostril retainer was different from that of patients treated with presurgical nasoalveolar molding and primary lip and nose surgery alone. This cross-sectional, retrospective review focused on 50 consecutive patients with nonsyndromic unilateral cleft lip and palate: 24 treated with nasoalveolar molding and primary lip and nose surgery followed by postsurgical nostril retainer (group 1) compared with 26 patients treated with nasoalveolar molding and primary lip and nose surgery without postsurgical nostril retainer (group 2). Polyvinyl siloxane nasal impressions were performed at an average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparisons of cleft-side versus noncleft side nasal measurements were performed within group 1 and group 2, as well as comparisons of differences between the two groups. Cleft-side nasal dimension was statistically significantly better in group 1 than in group 2 across all measures except nasal projection ( p < 0.05). Group 1 showed less difference between the cleft side and noncleft side in all six measurements than did group 2 ( p < 0.05). There was a significant difference in the nasal shape of patients who used a postsurgical nostril retainer compared with those who did not. Patients who used a postsurgical nostril retainer showed better nasal shape at an average age of 12 months compared with the control group. Therapeutic, III.

PRE-SURGICAL NASOALVEOLAR MOULDING - A REVIEW

The most common congenital defects of the orofacial region involve the clefts of the lip, alveolus and palate which lead to a signicant number of skeletal and soft tissue deformities of the lips, nose and facial bones. The clefts may be quite extensive , thus presenting a greater surgical challenge in the approximation of anatomic structures. Restoration of the normal anatomy and function serves as the primary goal of treatment in these patients. Presurgical Maxillofacial Orthopedics or Presurgical Nasoalveolar moulding is thus resorted to, with the help of custom made appliances and utilization of the growth potential of the baby. After an extensive search of literature, this review compiles and discusses the history and the principle behind PNAM along with the fabrication and application of the plate used to achieve nasoalveolar moulding .

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.

Does Presurgical Nasoalveolar Molding Reduce the Need for Future Bone Grafting in Cleft Lip and Palate Patients? A Systematic Review and Meta-Analysis.

Nasoalveolar molding (NAM) is a technique that is utilized in patients with cleft lip/palate before performing lip surgery. This procedure has been shown to result in a more aesthetic nose with lesser columellar deviation and reduced scaring. The aim of our study was to evaluate the long-term results of NAM and gingivoperiosteoplasty in patients with cleft lip and palate. An electronic search of databases (ie, PubMed, ISI Web of Science, EMBASE, Scopus, and Google Scholar) from inception to March 2021 was performed and after selecting the eligible studies, relevant data were collected using piloted extraction forms. The success rate of NAM and gingivoperiosteoplasty, and Bergland score were pooled using random-effects inverse variance meta-analysis. Seven studies were included in this meta-analysis and systematic review. The pooled mean success rate of NAM with gingivoperiosteoplasty (GPP) based on the continuity of alveolar bone structure was 71% (95% confidence interval [CI] = 54-85). This means that in 71% of cases NAM + GPP treatment eliminated the need for future bone grafts. Also, no significant difference between the success rate (risk ratio = 1.00, 95% CI = 0.64-1.58) and mean Bergland score (mean difference = 0.64, 95% CI = -1.04 to 2.31) of NAM + GPP and skeletal bone graft was found. Nasoalveolar molding and gingivoperiosteoplasty was successful in 71% of cases treating patients with cleft lip and palate. This treatment is similar with the secondary alveolar bone graft in both the success rate and the alveolar height that it generates while being less invasive and with lower morbidity.

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.

Recent Advances in Nasoalveolar Molding Therapy Using 3D Technology.

Presurgical Nasoalveolar Molding (NAM) is an adjunctive treatment modality designed to reorient misaligned tissue structures and nasal cartilage in cleft lip and/or palate (CL/P) patients. Recent advances in NAM therapy focus on modifications to the intraoral molding plate or nasal stent intended to improve treatment outcomes, ease of use, compliance, and cost-effectiveness. Notably, 3D technological advancements have been employed to design NAM devices more efficiently and create objective, standardized means of measuring progressive morphological changes during therapy. These advances are designed to incorporate 3D technology in the treatment of cleft lip and/or palate to render it more precise, accurate, and time-efficient.

English

BACKGROUND Cleft individuals have a significant altered growth of the craniofacial structures since birth. The treatments available for infants are mostly associated with controversies regarding timing of initiation, types &amp; timing in surgery, grafting etc. Maxilla is affected in all three dimensions; due to surgery alone or in conjugation with the infant orthopaedics, intrinsic growth retardation or combination of all. Considering the current conflict over the use of pre-surgical nasoalveolar molding (PNAM) and to evaluate the efficacy of PNAM technique, this postdoctoral research was done to compare the maxillary palatal volume in unilateral cleft lip and palate (UCLP) cases treated with and without PNAM as compared to non-cleft individuals. METHODS This is an observational cross-sectional study. The palate alveolar volume was assessed and analysed using 3D-DVT angiography machine. RESULTS There was significant difference between cleft group and non-cleft individuals. The cases treated with PNAM had lesser palatal volume. CONCLUSIONS Restrictive effect on maxilla was evident in PNAM cases, but this altered growth could also be an amalgamation of numerous factors like surgery, infant orthopaedics, and intrinsic growth. Therefore, judicious use, current concepts, and biomechanics of PNAM is the need of an hour. KEY WORDS Maxillary Palatal Volume, Unilateral Cleft Cases, Presurgical Naso-Alveolar Molding, 3D-DVT

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: an advantageous adjunctive neonatal therapy for cleft lip and palate defects in 2 clinical cases

The most common congenital craniofacial anomalies are labial-alveolo-palatal clefts. Infants with these deformities may have problems and limitations with breathing, feeding, speaking, hearing, as well as psychological problems. The treatment protocol for these patients is carried out using an interdisciplinary approach. Thus, in addition to surgical reconstruction, presurgical neonatal orthopedics have shown considerable advantages in the treatment of such malformations. Recently, presurgical nasoalveolar molding (PNAM) has been introduced to prevent nasal deformities, and to obtain a satisfactory surgical result and good psychological reintegration. This article describes, through 2 clinical cases, the technique of preparation of PNAMs, their surgical and clinical advantages, as well as the role of a multidisciplinary approach in effectively managing disorders related to labio-alveolo-palatal clefts.

Role of presurgical nasoalveolar molding in the repair of unilateral cleft lip

Aim: A study aims to reappraise the merits of nasoalveolar molding before the repair of unilateral cleft lip. Materials and Methods: A prospective study was conducted with 20 cases of the unilateral complete cleft lip for 3 years. We counseled the parents, offered them to choose the surgical procedure with/without preoperative nasoalveolar molding (NAM), and obtained consent from them. The nasolabial closure was done either after aligning the cleft segments with NAM or without preoperative NAM. The patients were followed up for 1 year and assessed. Both groups are then compared with normal healthy individuals of the same age group. Results: Depending on preoperative NAM, the patients were divided into Groups A (without NAM) and B (with NAM). All the facial proportions and angles (except oral commissural width: facial width and nasal tip angle) of Group B are much closer to the values of normal age-controlled individuals. However, a significant difference existed between the Group A values and normal individuals. Group B showed better nasal symmetry and restoration of normal proportions. The quality of scar produced was significantly superior in Group B when compared to Group A. Body weight change was also significantly different in the two groups. Group B seemed to catch the 15th percentile while Group A stayed at the 3rd percentile in the postoperative period. Conclusion: Presurgical NAM helps to restore the normal facial proportions and produces a healthier scar. Furthermore, the bodyweight of patients seems to improve as the NAM plate acts as a feeding plate.

Effectiveness of Presurgical Nasoalveolar Molding Appliance in Infants With Complete Unilateral Cleft Lip and Palate.

To assess the effectiveness of the presurgical nasoalveolar molding appliance among infants with unilateral cleft lip and palate. In this prospective study, 95 pairs of casts of infants with unilateral cleft lip and palate treated by presurgical nasoalveolar molding were selected at the Children's Hospital 1 at Ho Chi Minh City, Vietnam. The average time of treatment was 3 months. All casts were scanned and measured using 3-dimensional technology before and after treatment. Paired t tests were applied for comparisons. There was a statistically significant increase in the nostril height in cleft side (P < .001), decrease in the nostril width and columella angle (P < .001), and decrease in cleft width and midline deviation (P < .001) after treatment with presurgical nasoalveolar molding appliance. Nasoalveolar molding appliance is effective in improving the morphology of nostril and maxillary alveolar. Understanding this helps orthodontists and surgeons in treatment outcome expectations.

Nasal Aesthetic Evaluation Following Pre-Surgical Naso-Alveolar Molding Application: A Single-Blinded Cohort Retrospective Study in Indonesia

Introduction: As a major facial aesthetic unit, the nose is one of the significant features in cleft lip and palate repair. The use of a naso-alveolar molding (NAM) device was known to help narrow the cleft gap and improve nasal aesthetics. This study aims to evaluate post-operative nasal morphology in unilateral cleft lip and palate patients who had used presurgical NAM, particularly in an established craniofacial centre in one of developing countries. Methods: A cohort retrospective study was conducted at Cleft Craniofacial Centre, Cipto Mangunkusumo Hospital Indonesia, comparing the nasal symmetry in unilateral cleft lip patients with and without prior application of NAM (NAM and control group), twelve months following primary cheiloplasty. Differences between the cleft and normal side were assessed using standard basilar view photographs based on five points nasal measurements. Results: A total of twelve patients were enrolled, six with a history of NAM application and six without (control). Overall nasal measurements confirmed a lower mean of differences in the NAM group compared to the control, showing statistically significant results in nostril height, nasal dome height, and columellar height (p &lt;0.05). Conclusion: This study provides an insight that cleft lip patients with a history of NAM application had superior nasal symmetry compared to patients without presurgical NAM application 1-year post-cheiloplasty. Presurgical NAM application is recommended for patients with unilateral cleft lip and palate.

The Impacts and Outcomes of Presurgical Nasoalveolar Molding (PNAM) in Newborn Sequential Therapeutic Implementation

Cleft lip and palate is a common congenital malformation in the oral and maxillofacial regions. According to epidemiological investigation, the incidence rate is about 1.625%, and the incidence rate is high in poor areas and rural areas. Cleft lip and palate mainly involve the upper lip, hard palate, soft palate and nose, which can damage the appearance of children, affect pronunciation, swallowing and chewing, and also bring different degrees of psychological damage to children in the growth stage. Therefore, we should actively carry out sequential treatment and participate in the treatment work through multi-disciplines. Based on restoring the oral and maxillofacial function and health of children, we should also pay attention to their aesthetic needs, enhance the treatment confidence of parents and children, and lay the foundation for the follow-up repair treatment. Most patients with cleft lip and palate are complicated with malocclusion. Orthodontic treatment is an important part of the treatment of cleft lip and palate. The orthodontic treatment of cleft lip and palate can be divided into five periods: newborn period, deciduous dentition period, mixed dentition period, permanent dentition period and combined orthodontic and orthognathic treatment period. Presurgicalnasoalveolar molding (PNAM) was used to reduce the severity of facial deformity in children with cleft lip and palate. This article discusses the therapeutic effect of newborn PNAM according to clinical cases. Objective to study the opportunity and current situation of PNAM in the treatment of children with cleft lip and palate, and to provide a favorable reference for clinical orthodontists, emphasizing the close communication between various disciplines.

Complications During Grayson Presurgical Nasoalveolar Molding Method in Nonsyndromic Infants With Complete Unilateral Cleft Lip and Palate.

Within the treatment protocols of patients with cleft lip and palate, the nasoalveolar molding (NAM) acquire more followers every day.Their benefits have been well documented, but not equally their complications. The purpose of this study was to describe the complications produced during treatment with Grayson presurgical NAM in nonsyndromic infants with complete unilateral cleft lip and palate. Bibliographic review on 8 databases using search algorithms. By applying the exclusion and inclusion criteria, 21 articles were detected, which were analyzed in full text. Complication, cause, and solution data were presented in supplemental tables. Complications are related to soft tissues, hard tissues, and those derived from care. irritation, ulceration, gingival, facial, or nasal bleeding. Candidiasis. An overexpanded nostril creation to improper placement or modifications of the nasal stent at home.The most frequent were lip and cheeks skin irritation by taping, and gingival ulceration due to excessive pressure. misalignment of alveolar segments and the premature eruption of teeth. inadequate device retention, adherence problems to treatment, poor/excessive care of the caregiver, intolerance to the device, eating problems, breathing, and socioeconomic issues. The main complications occur in soft tissues, related to the retention mechanisms and an inadequate adjustment of the device.The benefits of NAM exceed the complications. It is necessary to know them to avoid any harmful results since they could prolong or stop the treatment, compromising the result. The active collaboration of the family in the insertion and maintenance of the device is crucial for success.