International Journal of Biomedicine. 2023;13(2):342-345.
Originally published June 5, 2023
Through this research, we have presented a modified presurgical nasoalveolar molding (PNAM) device, protocol, and equipment of preoperative nasal alveolar formation techniques to improve lip, nose, alveolar, and palatal deformity in the Department of Orthodontics and Maxillo-Facial Department at the University of Prishtina. A two-week-old boy was brought to our Department of Orthodontics. The baby was diagnosed with non-syndrome bilateral complete cleft of the primary and secondary palate. After a complete examination and orthodontic therapeutic planning, precaution was taken for creating a PNAM appliance and sent to the laboratory. An intraoral molding plate was established on both sides of the separate segments of the maxilla and fixed with a mini screw to approximate the maxillary segments. Parts of the strings built in the front side activated (please check) and, together with the nasal stent, were added to correct the nose deformity. By using modified NAM to close the cleft segments, both the ones of the upper lip and the ones of the palate, we achieved the same results and reduced possible tissue damage by maintaining the conventional NAM apparatus. We used an alveolar formation plate with traction stainless steel to reduce the separate parts. Under this presurgical treatment, the cleft alveolus and palatal segments were reduced considerably. Also, the parts of the flatting nasals of the nose were set up.
Through interdisciplinary work, we created a new modified NAM appliance to avoid the obstacles of the traditional NAM devices and to improve the presurgical treatment by using the benefits of the postnatal period of the child to have a more effective treatment. Despite the inability of previous studies to decide on the degree of efficacy of PNAM and the fact that scientific data is limited, we consider that our research can contribute to a better understanding of why it is essential to use PNAM and of the need to enhance the apparatus.
- Punga R, Sharma SM. Presurgical orthopaedic nasoalveolar molding in cleft lip and palate infants: a comparative evaluation of cases done with and without nasal stents. J Maxillofac Oral Surg. 2013 Sep;12(3):273-88. doi: 10.1007/s12663-012-0434-y.
- Abramowicz S, Cooper ME, Bardi K, Weyant RJ, Marazita ML. Demographic and prenatal factors of patients with cleft lip and cleft palate. A pilot study. J Am Dent Assoc. 2003 Oct;134(10):1371-6. doi: 10.14219/jada.archive.2003.0053.
- Marazita ML. Genetic etiologies of facial clefting. In: Mooney MP, Siegel MI, eds. Understanding craniofacial anomalies: The etiopathogenesis of craniosynostosis and facial clefting. New York: Wiley; 2002:147-62.
- Matsuo K, Hirose T. Nonsurgical correction of cleft lip nasal deformity in the early neonate. Ann Acad Med Singap. 1988 Jul;17(3):358-65.
- Oliveira NV, Tou GAA, Silva RS, Rezende SE, Pretti H, Macari S. The First-Year Follow-Up of a Cleft Lip and Palate Patient Treated With Nasoalveolar Molding (NAM). Braz Dent J. 2020 Jan-Apr;31(2):190-196. doi: 10.1590/0103-6440202003040.
- Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg. 1993 Dec;92(7):1422-3.
- Figueroa AA, Polley JW, Cohen M. Orthodontic management of the cleft lip and palate patient. Clin Plast Surg. 1993 Oct;20(4):733-53.
- Liou EJ, Subramanian M, Chen PK. Progressive changes of columella length and nasal growth after nasoalveolar molding in bilateral cleft patients: a 3-year follow-up study. Plast Reconstr Surg. 2007 Feb;119(2):642-8. doi: 10.1097/01.prs.0000239600.79638.6f.
- Patil PG, Nimbalkar-Patil SP. Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate. J Prosthodont. 2018 Jan;27(1):94-97. doi: 10.1111/jopr.12464.
- Maillard S, Retrouvey JM, Ahmed MK, Taub PJ. Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review. J Oral Maxillofac Res. 2017 Sep 30;8(3):e2. doi: 10.5037/jomr.2017.8302.
- Hassani H, Chen JW, Zhang W, Hamra W. Comparison of Microbial Activity Among Infants With or Without Using Presurgical Nasoalveolar Molding Appliance. Cleft Palate Craniofac J. 2020 Jun;57(6):762-769. doi: 10.1177/1055665620908150.
- Levy-Bercowski D, Abreu A, DeLeon E, Looney S, Stockstill J, Weiler M, Santiago PE. Complications and solutions in presurgical nasoalveolar molding therapy. Cleft Palate Craniofac J. 2009 Sep;46(5):521-8. doi: 10.1597/07-236.1.
- Sazo JS, Molina RT, Fierro-Monti C, Pérez-Flores A. Presurgical orthopedics in patients with cleft lip and palate: nutrition, aesthetics and gap between maxillary segments. A systematic review. Odontoestomatología. Montevideo 2021;23(38). Epub 30-Sep-2021
- Seo HJ, Denadai R, Lo LJ. Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis. J Clin Med. 2019 May 1;8(5):602. doi: 10.3390/jcm8050602.
- Rossell-Perry P, Olivencia-Flores C, Delgado-Jimenez MP, Ormeño-Aquino R. Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review. Plast Reconstr Surg Glob Open. 2020 Sep 24;8(9):e3082. doi: 10.1097/GOX.0000000000003082.
- Marcus JR, Allori AC, Santiago PE. Principles of Cleft Lip Repair: Conventions, Commonalities, and Controversies. Plast Reconstr Surg. 2017 Mar;139(3):764e-780e. doi: 10.1097/PRS.0000000000003148.
Received April 20, 2023.
Accepted May 24, 2023.
©2023 International Medical Research and Development Corporation.