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Standard anthropometric measurements: (a) nostril dome height; (b) columella length; (c) alar width; (d) lip height; (e) vermilion height; (f ) lip width; (g) nasal base width.
Source publication
The purposes of this study were to evaluate surgical outcomes after primary surgery to address unilateral cleft lip, nose, and palate deformities and to perform a review of the literature to evaluate the effects of nasoalveolar molding (NAM) plus primary surgical repair on nonsyndromic unilateral cleft lip and palate.
Methods:
A cohort study of 3...
Contexts in source publication
Context 1
... parents of each child were informed about the nature of the surgical techniques used, and the parents provided signed consent before the surgery. The inclusion criteria were as follows: Preoperatively, all patients underwent the following measurements, as shown in Figure 1: (a) Columellar angle: This is measured using a transparent protractor as described by Fisher, considered as the angle of deviation from the sagittal plane. 7 (b) Alveolar cleft width: This is the distance measured between points A (gingival ridge of the cleft, crest of the alveolar ridge) and B (most dorsal point of the premaxilla contour, medial segment). ...
Context 2
... significant changes were observed with regard to pre-and postoperative columellar angle and alveolar cleft lip, whereas nonstatistically significant differences were found between the cleft and noncleft sides regarding nostril dome height, nasal base width, alar base position, columellar length, lip height, and vermilion height (Tables 1 and 2; Figs. 4-7, 9-16). Observed differences in the lip width are associated with congenital hypoplasia on the cleft side of the lip. This condition has been reported by others. 27,28 Observed complications were low (5.4% of scar contracture and 2.7% of synechia) in comparison with similar studies, and all were well addressed without any additional surgery. ...
Context 3
... changes were observed for the alveolar cleft (Table 1). The primary surgery allowed us to correct the alveolar gap in a more physiological form (Figs. 12, 16). Changes in the alveolar gap width and transverse dental arch relationships have been described by different groups following primary cheiloplasty. ...
Similar publications
Introduction:
The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced.
Aims:
This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to...
Cleft lip and palate is a congenital maxillofacial deformity. Unilateral complete cleft lip and palate is one of the most common clinical types. Nasal alveolar molding (PNAM) is a recognized strategy for the treatment of cleft lip and palate. However, the current design of PNAM devices mainly relies on the subjective experience of doctors. The purp...
Statement of problem. Cleft Lip and Palate (CLP) are common congenital defects of the present day. They result from a failure of facial bud sticking during embryological phenomena. Their therapeutics based on multi-disciplinary care to restore as much as possible the aesthetic and functional prejudices generated by these anomalies. Purpose. Through...
Introduction:
It is generally assumed that the major phenotypes of unilateral cleft lip (UCL) represent its extent of severity. There are a few studies on this, but objectivity has been lacking. It was the aim of this study to assess the effect of different phenotypes of UCL on the outcome of surgical repair.
Methodology:
This study was a case s...
Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry.
Methods:
Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion fl...
Citations
... The nose was repaired, preserving nasal tissues using the V-Y-Z technique and producing nasal vestibular lengthening of the cleft side (described previously as surgical "NAM"). 11,12 First, the lip and nose tissues were infiltrated using local anesthetic with 2% lidocaine in combination with epinephrine (1/10,0000 at the external branch of the anterior ethmoidal and infraorbital nerve blocks). An incision along the marginal and intercartilaginous borders created a composite flap (of vestibular skin and alar cartilage) in a V form. ...
... The same findings were observed in our previous study. 12 We observed a low rate of complications: granulomas, vestibular scar contracture, pinched nose, and synechiae (Table 3). Granuloma was the most common complication and was associated with transcutaneous stitches. ...
Background
Recently, there has been an increased acceptance of the primary cleft rhinoplasty providing acceptable outcomes. Nose reconstruction, and specifically cleft nose deformity, should be addressed based on this philosophy. The purpose of this study was to evaluate surgical outcomes during the mixed dentition period after primary surgery to address unilateral cleft lip nose deformity based on the proposed technique.
Methods
This is a retrospective cohort study. Thirty-two primary complete unilateral cleft lip patients were operated on by a single surgeon using the V-Y-Z cleft rhinoplasty. This method combines a composite V-Y advancement flap with lateral Z-plasty. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements performed under general anesthesia during primary cleft palatoplasty and alveolar bone graft. The outcomes were evaluated through anthropometric measurements of the repaired nose during the mixed dentition period of follow-up, and no type of presurgical management was performed for any of the patients.
Results
Total nasal symmetry has been observed in 34.37% of patients at 7 years or more and 40.62% at 1-year follow-up. Nonstatistically significant differences were observed during follow-up, and major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 9.37% of patients.
Conclusions
The proposed primary cleft rhinoplasty is a good approach to improve nasal appearance in patients with complete unilateral cleft lip and palate.
... Negative sculpturing, on the contrary, involves making serial changes to the inside surfaces of the molding appliance, such as adding or subtracting material in specific regions, in order to achieve the desired shape of both the alveolus and nose. 8,9 The idea behind preoperative NAM is to actively shape and reposition deformed in case of handling any emergency. The infant's head is held in a slightly upright position while the impression tray is placed into the oral cavity. ...
Aim and objective
The present clinical report describes management of complete unilateral cleft lip and palate with presurgical nasoalveolar molding (NAM) therapy for infants.
Background
Orofacial clefts have a negative impact on the health and social integration of individuals affected. Patients undergo numerous procedures until they reach adolescence. The ultimate focus of surgical intervention is to improve the esthetic appearance of the lip and nose by improving the lip scar, nasal tip projection, and symmetry of the nasolabial complex.
Case description
This paper discusses a situation in which the parents of a three days old baby with the chief complaint of regurgitation of milk while feeding. On examination, baby had complete left-sided cleft lip and cleft palate (CL+CP).
Conclusion
Before surgery, nasoalveolar molding has been shown to be a useful adjunctive therapy for reducing hard and soft tissue cleft deformity.
Clinical significance
Passive preoperative intervention of the lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcomes by minimizing wound healing disturbances and scarring.
How to cite this article
Shaik N, Eggula A, Pudi S, et al. Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report. Int J Clin Pediatr Dent 2023;16(4):659–662.
... The device acts indirectly on the cleft alveolar segments with force vector generated from traction of lip muscles, keeping the nostril airway less restricted and overall technique being less invasive. It is less expensive and easier for parents to manage Aligner -NAM Significant increase in the columella length with near-complete approximation of maxillary alveolar segment [20] Intraoral scanner for recording intraoral impressions is less hazardous and more accurate. Downside of acrylic plate such as ulceration is eliminated [20] SAC-PP-MR Technique A modified, economical, comparatively easier and faster technique reducing the defect to zero [12] A passive appliance stimulates the involved tissues during physiological functions like swallowing and feeding resulting in overcorrection of alar cartilage; the technique derives its basis from functional matrix theory Latham appliance ...
... It is less expensive and easier for parents to manage Aligner -NAM Significant increase in the columella length with near-complete approximation of maxillary alveolar segment [20] Intraoral scanner for recording intraoral impressions is less hazardous and more accurate. Downside of acrylic plate such as ulceration is eliminated [20] SAC-PP-MR Technique A modified, economical, comparatively easier and faster technique reducing the defect to zero [12] A passive appliance stimulates the involved tissues during physiological functions like swallowing and feeding resulting in overcorrection of alar cartilage; the technique derives its basis from functional matrix theory Latham appliance ...
Presurgical infant orthopaedic (PSIO) protocol is applied prior to cleft Lip and/cleft palate surgical intervention to facilitate the repair by restoring the alar base and maintaining the skeletal, soft tissue harmony. The objective of this review is to assess the literature on the presurgical infant orthopaedic protocol most widely used and accepted. Searches were made in PubMed, Cochrane and Google Scholar on cleft lip and/palate. A large number of articles documented approaching PSIO for cleft treatment with the intent to provide a satisfactory treatment for cleft patients, requiring far more than just correctional surgery and its ability to do so is unique. Craniofacial Orthodontists can choose from a wide array of treatment options for their patients and can learn from the outcomes attained by applying a combination of outcomes at various other centers.
... Negative sculpturing, on the contrary, involves making serial changes to the inside surfaces of the molding appliance, such as adding or subtracting material in specific regions, in order to achieve the desired shape of both the alveolus and nose. 8,9 The idea behind preoperative NAM is to actively shape and reposition deformed in case of handling any emergency. The infant's head is held in a slightly upright position while the impression tray is placed into the oral cavity. ...
Orofacial clefts have a negative impact on the health and social integration of individuals affected. Patients undergo numerous procedures until they reach adolescence. The ultimate focus of surgical intervention is to improve the esthetic appearance of the lip and nose by improving the lip scar, nasal tip projection, and symmetry of the nasolabial complex. Passive preoperative intervention of the CLEFT lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcomes by minimizing wound healing disturbances and scarring.
... Aligner -NAM significant increase in the columella length with near-complete approximation of maxillary alveolar segment [21]. ...
Presurgical infant orthopaedic (PSIO) protocol is applied prior to cleft Lip and/ cleft palate surgical intervention to facilitate the repair by restoring the alar base and maintaining the skeletal, soft tissue harmony. The objective of this review is to assess the literature on the presurgical infant orthopaedic protocol most widely used and accepted. Searches were made in PubMed, Cochrane and Google Scholar on cleft lip and/palate. A large number of articles documented approaching PSIO for cleft treatment with the intent to provide a satisfactory treatment for cleft patients, requiring far more than just correctional surgery and its ability to do so is unique. Craniofacial Orthodontists can choose from a wide array of treatment options for their patients and can learn from the outcomes attained by applying a combination of outcomes at various other centers.
Unilateral cleft lip and nasal deformity is characterized by noticeable asymmetry resulting from distorted and displaced soft tissue and bone structures. Surgical techniques to reconstruct a unilateral cleft lip and nasal deformity have evolved over time. However, the surgical care of patients with unilateral cleft lip and nasal deformity remains extremely variable between centers and surgeons across the globe. This chapter addresses the modern guiding surgical principles of unilateral cleft lip repair with the synchronous reconstruction of nasal deformity, highlighting the existing controversies surrounding this treatment such as the timing of unilateral cleft lip and nasal repair, presurgical orthopedics, cutaneous design, the primary approach of the alveolar cleft, treatment of the vermilion height deficiency, reconstruction of the nasal floor and intraoral linings, muscle repair, correction of the nasal deformity, and postoperative care (feeding, arm restraints, and hospital stay).
ZUSAMMENFASSUNG
Lippen-Kiefer-Gaumen-Spalten stellen insgesamt häufige Fehlbildungen dar. Ihre Versorgung beginnt bereits unmittelbar nach der Geburt und umfasst eine Vielzahl von Behandlungsschritten, welche sich nicht selten bis in das junge Erwachsenenalter hinein erstrecken. Die chirurgische Rehabilitation besteht in der plastischen Korrektur der betroffenen Anteile der Oberlippe, des Hart- und Weichgaumens und der Nase. Häufig ist zusätzlich eine Mittelohrsanierung erforderlich. Begleitend zu den operativen Maßnahmen erfolgen in regelmäßigen Abständen Konsultationen, um gegebenenfalls kieferorthopädische, logopädische, HNO-ärztliche oder auch zahnärztlich-sanierende Behandlungen zu koordinieren. Diese komplexe Betreuung erfordert eine gute Compliance der Betroffenen und Ihrer Eltern und ist nur in einem interdisziplinären Team mit entsprechender Expertise zu realisieren. Die Ergebnisse der Rehabilitation sind heute sehr gut und ermöglichen Betroffenen eine Lebensqualität, welche sich kaum noch von jener anderer Kinder bzw. Jugendlicher unterscheidet.
