Presurgical Nasoalveolar Molding Research Articles

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.

Presurgical nasoalveolar remodeling - an experience in the journey of cleft lip and palate.

Aims and objectivesTo assess the effect of presurgical nasoalveolar molding (PNAM) therapy in the management of patients with nonsyndromic unilateral cleft lip and palate (UCLP).Material and methodTen patients with UCLP treated from 2009 to 2012. The initiation for PNAM treatment was 7 days and the average time of the treatment was 175 days. Measurements on patients and of casts were made, and statistical analysis was used to evaluate the changes in pre- and posttreatment measurements.ResultsSubsequent to PNAM treatment, there was a statistically considerable rise in cleft nostril height and columellar width. There was reduction in both intraoral cleft width and columellar deviation, which was significant statistically.ConclusionPNAM treatment reduces alveolar cleft width. It enhances symmetry of the nose by changing columellar angulation, preserving alar width bilaterally, gaining height of the nostril on the affected side, and increasing columellar length.

Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review.

Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.

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...

양측성 구순/구개열을 가진 이란성 쌍둥이를 대상으로 한 술전 비치조정형술: 증례보고

구순구개열은 선천성 악안면 기형 중 발생률이 가장 높은 질환으로 관련된 여러 분야의 협진(team approach)을 통한 조직적인 관리를 필요로 한다. 치료에 있어 수술분야의 많은 발전이 있어 왔으나 수술만으로는 다양한 문제점을 해결하기 어려웠다. 이에 따라 술 전 처치의 필요성을 인식하여 술전 비치조 정형의 개념이 개발되었으며 편측성 및 양측성 구순구개열 환자에게 적용되고 있다. 편측성 구순구개열에서 술전 비치조정형의 목적을 코의 대칭성을 회복시키는데에 중점을 두었다면 양측성 구순구개열에서는 짧은 비소주를 신장시키고, 낮아진 코끝을 세우고, 전방으로 변위된 전상악부를 재위치 시키는 것이 목적이라 할 수 있다. 본 증례에서는 양측성 구순/구개열로 진단받은 이란성 쌍둥이에게 술전 탄성밴드와 비치조정형 장치를 이용하여 첫 번째 입술수술 전까지인 약 70일간 전상악부의 후방 견인 및 술전 비치조정형을 시행하였다. 두 환아 모두 초기에 비해 비소주가 길어지고 전방 변위된 전상악부가 제 위치로 많이 회복된 것을 관찰할 수 있었다. 그리고 입술 수술 후 술자와 보호자가 모두 만족할만한 심미적인 결과를 얻을 수 있었다. 장치의 효과를 극대화하기 위해서 환자의 적응력, 보호자의 협조도 및 술자의 적절한 장치물의 선택과 세심한 조정, 이 3가지 요소가 조화를 이루어야 할 것이다. Cleft lip and palate(CLP) is one of the most common craniofacial deformities that requires systemic management involving a multidisciplinary team approach. Although there has been great improvement in the field of cleft surgery, surgical approach alone cannot resolve the various problems in treating cleft lip and palate. Hence the need for presurgical treatment was appreciated and especially, the concept of presurgical nasoalveolar molding was applied to treat unilateral and bilateral cleft lip and palate patients. Presurgical nasoalveolar molding(PNAM) of unilateral cleft mainly aims to recover nasal symmetry while the objectives of pre-surgical nasoalveolar molding in the bilateral cleft are to elongate the columella, to erect the tip of nose, and to reposition the forward displaced premaxillary region. This report covers the case of fraternal twins diagnosed with bilateral cleft. Retraction of the premaxillary region and nasoalveolar molding were conducted for 70 days until cheiloplasty, using elastic bands and nasoalveolar molding appliances. After cheiloplasty, there had been improvements in the length of columella and the position of forward-displaced premaxilla for both patients compared to their initial states. The esthetics was also satisfactory for both the surgery and the parents. In order to maximize the efficacy of the appliance, three components should be in balance; patients' adaptation to the appliance, parents' cooperation and proper selection and careful adjustment of the appliance by the dentist.

Presurgical Treatment of Cleft Lip and Palate Babies with a PNAM Appliance: A Series of Four Case Reports

Embryonic development of the head and face are among the most complex prenatal developmental events. Any disturbance during the developmental stage can result in craniofacial abnormalities, and the timing of the disturbance and intensity of the interruption affect the severity and type of the anomaly. Cleft lip and palate are relatively common congenital malformations and are readily diagnosed. Treating cleft lip and palate defects is important because of the severe aesthetic, functional, and serious psychological problems faced by both patients and their parents. It is recommended that cleft lip and palate patients from 0 to 18 years old undergo treatment with a multidisciplinary team. In this series of clinical reports, we describe clinical orthodontic treatment approaches using a presurgical nasoalveolar moulding (PNAM) in newly born unilateral and bilateral cleft lip and palate babies. Three boys and one girl were selected from among other cleft lip and palate patients because some information about the possible aetiology of the clefts was observed and the parents were cooperative during treatment. The objectives of PNAM use in unilateral and bilateral cleft lip and palate patients are to presurgically decrease the severity of the cleft size, maintain a narrower cleft palate, and increase the length of the columella and height of the nostrils. With parental cooperation, the treatment goals were achieved in these cases.

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

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.

Nasoalveolar molding: A review

Cleft lip and palate (CLP) is the most common congenital defect of the oral cavity which possesses a serious socioeconomic trouble. It varies in form and severity. In these patients who have defi cient hard and soft tissue structures presented a major task to bring about a functional and cosmetic outcome. Recently, nasoalveolar molding (NAM) has gained more attention as it improves facial appearance and function. The objectives of presurgical NAM involves correcting lip segments, lower lateral alar cartilages, and alveolar cleft segments. Results of NAM are promising for CLP, hence are encouraged to be used promptly after the birth and continued till further specifi c corrective surgeries are performed.

편측성 구순구개열 신생아에 대한 술전비치조정형장치의 효과

구순구개열은 얼굴에 발생하는 다양한 종류의 기형 중 빈번히 발생하는 기형으로, 발생 빈도는 일반적으로 1000명당 0.28~3.74명으로 알려져 있으나 파열의 종류, 인종 및 성별에 따라 큰 차이를 보인다. 구순구개열의 치료는 수술영역에서 많은 발전이 있었지만 수술만으로는 문제점을 해결하기는 어렵다. 파열부 간격을 줄이고 구순열 수술을 용이하게 하기 위한 술전 신생아 정형술의 개념이 1950년 McNeil에 의해 개발되었으며, 최근에는 술전 비치조 정형장치(presurgical nasoalveolar molding appliance, PNAM)를 사용하여 치조골뿐만 아니라 코의 모양을 정상화하려는 시도가 이루어지고 있다. 세 명의 환자가 편측성 구순구개열로 진단받은 후 술전비치조정형장치 장착을 위해 의뢰되었다. 레진과 교정용와이어를 이용하여 제작한 K-NAM 장치물을 입술 성형 수술을 시행하기 전까지 장착하였다. 첫 내원시와 nasal molding을 시행하여 입술 성형 수술을 하기 직전, 입술 성형 수술 이후 콧구멍의 높이, 너비, 비주의 각도를 측정하여 비교한 결과 세 증례에서 모두 코의 대칭성이 증가하며 술 후 심미개선에 효과적임을 알 수 있었다. K-NAM 장치물은 장치의 장착, 유지, 조절이 용이하고 장착한 상태에서 수유가 가능하기 때문에 장착시간을 증가시킬 수 있다. 따라서 nasal molding이 가능한 한정된 기간 안에 최대의 효과를 기대할 수 있다. 그리고 젖병을 빠는 행위가 가능해짐으로써 동시에 구강조직의 발달에도 도움을 줄 수 있을 것이라 생각한다. Cleft lip and palate, the most common craniofacial anomalies, are severe congenital defects that have an incidence of 0.28 to 3.74 per 1000 live births. Although there has been great improvement in the field of cleft surgery, surgical approach cannot be the single solution to resolve the various problems encountered in patients with cleft lip and palate. The concept of presurgical infant orthopedics (PSIO) for gradual closure of the cleft gap and simplified surgical performance was first introduced by McNeil in 1950. Recently, there are many attempts not only to approximate the alveolar segments but also to reshape the nasal cartilage. Three infants with unilateral cleft lip and palate were referred from the department of Plastic Surgery for presurgical nasoalveolar molding (PNAM). Maxillary appliances using resin with orthodontic wire were fabricated. Then these appliance was applied until patients underwent lip surgery. In all cases, the patients could wear the appliance all day since they were able to eat even with the appliance on, This resulted in significant improvements in the nasal symmetry were found. Our appliance, namely K-NAM, extends the wearing time within the limited period and as a result it is expected to maximize the treatment effects. Used properly, this appliance would play a major role in enhancing nasal symmetry with satisfactory results.

Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: A clinical report

PatientA 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention. DiscussionThe alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate. ConclusionAs a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.

Nasoalveolar moulding for children with unilateral cleft lip and palate.

Cleft lip and palate represents the most frequently occurring congenital deformity second only to club foot deformity in our country. Wide alveolar clefts if not preceded by pre surgical orthodontic adjuncts like nasoalveolar moulding, may affect the final outcome of the primary surgery. Presurgical nasoalveolar moulding is to align and approximate the alveolar cleft segments while at the same time achieving correction of the nasal cartilage and soft tissue deformity. The device we used is designed by Barry Grayson. It is simple to fabricate, causes less discomfort to the patient and optimum results are achieved in three months of time, compared to other complicated appliances like Latham's which are more invasive. A child of 3 months presented with a complaint of unilateral cleft deformity on one side of the face. After three months of nasoalveolar moulding considerable changes were observed. The widths of the cleft alveolus were reduced and the nasal contours of columella on the cleft side showed considerable improvement.

Evaluation of pre- and post-treatment changes in the alveolus of infants with cleft lip and palate using nasoalveolar molding

Objectives: The purpose of this study was to evaluate the changes in maxillary alveolar morphology in unilateral and bilateral cleft lip palate infants treated with presurgical nasoalveolar molding (PNAM). Materials and Methods: In this retrospective study, 10 infants, less than 6 months of age, with cleft lip and palate (CLP) treated with PNAM prior to surgical repair, were evaluated. Pre-PNAM (T1) and Post-PNAM (T2) study models were analyzed. Critical linear dimensions like inter-canine width, inter-tuberosity width, and arch length were measured and compared at the T1 and T2 stages using a grid comparison system. Results: The width of the alveolar cleft, arch length, and arch width showed a significant decrease in infants treated with PNAM. The inter-tuberosity width and arch perimeter showed a statistically significant increase with PNAM. Conclusion: PNAM was effective in reducing the severity of the initial cleft deformity mainly at the anterior portion of the maxillary arch.

Presurgical Nasoalveolar Moulding—An Adjunct to Facilitate Surgical Repair in Infants with Cleft Lip and Palate

Presurgical orthopedics forms an integral part of the treatment of patients with facial clefting. The primary aim of presurgical nasoalveolar moulding (PNAM) is reduction in the soft tissue and cartilaginous deformity to facilitate surgical soft tissue repair in optimal conditions under minimum tension to minimize scar formation. It also helps in reducing the nasal deformity with a nasal stent which brings the deformity near to the normal and forms an important part of the primary nasal repair at the time of primary lip repair. A soft acrylic relining material is added or removed to line the appliance to a thickness of approximately 1 - 1.5 mmin the region from where the bone is to be resorbed or apposed. This article describes the fabrication procedure of the modified nasal alveolar molding appliance in eight infants with unilateral cleft lip and palate in whom a significant reduction in cleft width and nasoalveolar deformity was achieved. The results showed that the greater segment shows more favourable changes and can be molded more positively and efficiently than the lesser segment.

Supporting the Drive to Thrive in Cleft Lip and Palate Infant- A Case Report

In infants with cleft lip and palate, failure to thrive (FTT) condition has largely been attributed to early feeding difficulties. Presurgical Nasoalveolar Molding (PNAM) forms an integral part of treatment modality for cleft infants in such conditions, by providing a myriad of benefits.It balances several aspects of treatment such as growth, aesthetics and function in cleft infants and also provides psychological reassurance to the parents. This clinical report describes the presurgical management of an infant with complete unilateral cleft lip and palate who was in failure to thrive condition.

Presurgical Nasoalveolar Molding and Primary Gingivoperiosteoplasty Reduce the Need for Bone Grafting in Patients with Bilateral Clefts

Preoperative nasoalveolar molding (NAM) in combination with primary gingivoperiosteoplasty (GPP) reduces the need for secondary alveolar bone grafting by 60% in patients with unilateral cleft lip and palate (CL/P). Herein, we investigate the efficacy of NAM and primary GPP in patients with bilateral CL/P. All patients (n = 38) with bilateral CL/P who underwent NAM and primary GPP from 1988 to 1998 with at least 14 years of follow-up were included in this study. Panoramic and periapical radiographs were used to assess dentoalveolar bone formation. A total of 38 patients were identified with median follow-up of 18 years (range 14-26 years). Of the 27 patients who underwent bilateral GPP, 14 (51%) patients had successful dentoalveolar bone formation bilaterally and 13 (49%) had unilateral bone formation. No patient had a bilateral failure. Of the 11 patients who underwent unilateral GPP, 7 (63%) patients had successful dentoalveolar bone formation. Bilateral successful dentoalveolar bone formation following primary bilateral GPP has a dependent probability of 52% and a conditional probability of 82%.

Limited Evidence for the Effect of Presurgical Nasoalveolar Molding in Unilateral Cleft on Nasal Symmetry

In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term. A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch. The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects. Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding. Therapeutic, III.

Nasal Changes after Presurgical Nasoalveolar Molding (PNAM) in the Unilateral Cleft Lip Nose

Nasal reconstruction for patients with unilateral cleft lip and palate (UCLP) is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding (PNAM) was introduced to reshape the cleft nasal structures prior to lip repair. This study analyzed two-dimensional nasal changes before and after PNAM in patients with complete UCLP. Thirty UCLP patients (19 males; 11 females) who received PNAM before lip repair were included in this study. PNAM was applied for 100 days. Nasal casts were obtained before and after PNAM. Frontal and 45° standardized digital photographs were taken from all casts, and a photogrammetric analysis (16 linear, six angular, and two area measurements) was performed. Paired Student's t tests were used to search for differences by time, and time versus side (cleft versus noncleft). Significant reduction of cleft columella deviation with an increase in columella length, nostril height, and axial inclination on the cleft side were recorded. This resulted in an increase in the projection of the nasal tip. The noncleft measurements remained without significant changes. The cleft nostril area increased significantly more than the noncleft side by 90% with PNAM treatment. Significant normal growth changes were observed in nasal width and nasal height. A favorable reshaping of the nose after PNAM was achieved, resulting in an improvement in form before lip surgery. These changes lead to improved nasal symmetry before primary lip and nasal reconstruction in UCLP patients.

Presurgical Nasoalveolar Molding Orthopedic Treatment Improves the Outcome of Primary Cheiloplasty of Unilateral Complete Cleft Lip and Palate, as Assessed by Naris Morphology and Cleft Gap

We evaluated the effects of presurgical nasoalveolar molding (NAM) with an orthopedic appliance and compared them with a passive orthopedic method (Hotz plate, HP), focusing on the naris morphology and width of the alveolar and palate cleft gap. The subjects were 28 unilateral complete cleft lip and palate patients treated with primary cheiloplasty at Tsukuba University Hospital from 2004 to 2011. Thirteen patients were treated preoperatively with NAM (NAM group), and 15 with HP (HP group). The surgical outcome was assessed according to left-right naris symmetry, as measured by the area ratio, perimeter ratio, aspect a/u ratio (aspect ratio of the affected side/aspect ratio of the unaffected side), and Hausdorff distance. In addition, the alveolar and palate cleft width was measured at the times of orthopedic plate setting and primary cheiloplasty. The aspect ratio was significantly smaller in the NAM group than in the HP group before the operation. In both groups, the aspect ratio, perimeter ratio, and Hausdorff distance were significantly smaller after the operation than before. The width of the alveolar and palate cleft gap was significantly narrowed in the NAM group, and the cleft gap at the initiation of NAM correlated significantly with the Hausdorff distance after cheiloplasty. We found that NAM improved the form of the naris after primary cheiloplasty and decreased the palate cleft gap more effectively than HP and that the width of the palate cleft gap was correlated with the surgical outcome of the naris.

Presurgical Nasoalveolar Molding in a Neonate With Bilateral Cleft Lip and Palate: Report of a Case

Background: Cleft lip and palate as the most common congenital defect of oral cavity possesses a heavy socioeconomic burden for both the child and parents. Nasoalveolar molding (NAM) has received more attention to enhance future facial appearance and function during recent decades Case Presentation: A 21-day old female neonate was referred with a bilateral cleft lip and palate. Parents complained of frequent bouts of cyanosis during feeding. The infant was a type IV cleft patient which was healthy systematically. An acrylic prosthetic obturator was fabricated which covered the palatal defect with a few millimeters extension into the nasal chamber. After a week, an extraoral tension was added to ensure the posterior protraction of upward and anterior displaced prolabium. Frequent adjustments were performed until the cleft lip operation and afterward to follow the centralization of the lateral maxillary segments and muscular tension changes after the cleft lip operation. The parents were highly satisfied with enhanced appearance and feeding and the patient was followed by the age of one year. Conclusions: According to the recent promising outcomes of NAM for cleft lip and palate, this method is encouraged to be applied promptly after the birth and to be continued till further provisional or definite corrective surgeries.

Presurgical Nasoalveolar Molding in a Neonate With Bilateral Cleft Lip and Palate: Report of a Case

Background: Cleft lip and palate as the most common congenital defect of oral cavity possesses a heavy socioeconomic burden for both the child and parents. Nasoalveolar molding (NAM) has received more attention to enhance future facial appearance and function during recent decades Case Presentation: A 21-day old female neonate was referred with a bilateral cleft lip and palate. Parents complained of frequent bouts of cyanosis during feeding. The infant was a type IV cleft patient which was healthy systematically. An acrylic prosthetic obturator was fabricated which covered the palatal defect with a few millimeters extension into the nasal chamber. After a week, an extraoral tension was added to ensure the posterior protraction of upward and anterior displaced prolabium. Frequent adjustments were performed until the cleft lip operation and afterward to follow the centralization of the lateral maxillary segments and muscular tension changes after the cleft lip operation. The parents were highly satisfied with enhanced appearance and feeding and the patient was followed by the age of one year. Conclusions: According to the recent promising outcomes of NAM for cleft lip and palate, this method is encouraged to be applied promptly after the birth and to be continued till further provisional or definite corrective surgeries.