Presurgical nasal moulding in a neonate with cleft lip (original) (raw)
Related papers
The Cleft Palate-Craniofacial Journal, 2001
Cleft Palate Craniofac J. 2000;37:528-532), offers an extended perspective on this controversial subject. This article reviews the role of combined nasal and alveolar (nasoalveolar) molding in the primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. The background of presurgical nasoalveolar orthopedic molding, the technique, and the literature are presented. The proposed benefits of treatment from the traditional techniques of presurgical orthopedics have been shown to be unsubstantiated (Kuijpers-Jagtman and Prahl, 1996). A close comparison of the proposed benefits of earlier forms of presurgical orthopedics, along with those of the current technique of nasoalveolar molding, is presented.
Cureus, 2024
The occurrence of congenital deformities like cleft lip and palate is not uncommon and is often a traumatizing experience for families. The entire rehabilitation process includes frequent hospital visits and the brunt of numerous procedures. Early intervention with pre-surgical infant orthopedics facilitates better surgical outcomes and additional psychosocial benefits to the infant's family. The present clinical report addresses the pre-surgical management of a non-syndromic two-day-old female baby whose parents presented with the chief complaint of deformed lips, nose, and difficulty while feeding. The neonate had a complete left-sided cleft lip, alveolus, and cleft palate on examination. Early management with pre-surgical passive nasoalveolar molding (PNAM) has favorable outcomes, including desired upper lip, alveolus, and nose shape. Non-invasive pre-surgical intervention with PNAM reduces the severity of the deformities before the primary surgical repair, thus decreasing the overall cost of cleft care and the number of secondary revisions, thus increasing the probability of favorable outcomes.
Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report
International Journal of Clinical Pediatric Dentistry, 2023
of consanguineous marriage. On the first visit, parent counseling regarding the diet was done with audiovisual aids and live demonstrations were given, followed by the interaction with parents of other patients. The treatment planned was dynamic presurgical nasal remodeling appliance, followed by lip and palatal repair. 4 After informing the parents about the treatment protocol, parent consent was taken for the NAM technique. Silicone impression materials were used to take impressions of the palate, cleft lip, and nose complex. During this impression recording phase, a surgeon is always present IntroductIon Cleft lip and palate (CLP) are considered common congenital deformities inherited, leading to craniofacial malformation that escorts to various dental abnormalities in the early stages of life. According to the World Health Organization, the prevalence of an orofacial cleft at birth varies worldwide, ranging from 3.4 to 22.9/10,000 births. 1 Occurrence of a cleft lip, with or without cleft palate (CL ± P) and cleft palate (C+P) alone is one in every 500-1,000 births worldwide. 2 A child with this condition not only has poor dental development but also cannot breastfeed because of nasal regurgitation, improper oral seal, and swallowing. They are also inclusive of other issues like difficulties in hearing, primarily due to palatal musculature abnormalities, speech adversities caused due to nasal escape, and other articulation problems. 3 Though orofacial cleft anomalies can be corrected in early childhood, scarring, aberrant face growth, and development result in ongoing functional and psychosocial issues. To treat the causes of CLP, an interdisciplinary team is required to meet the standard of treatment apart from surgical intervention. The left side cleft is most often found in unilateral cases. Although the diagnosis of cleft lift and palate is simple, it could be challenging to handle a few days old baby. Here, we demonstrate the management of unilateral complete CLP in a case series. case descrIptIon A 26-year-old female with her 3-day-old female baby reported to the
Egyptian Journal of Oral and Maxillofacial Surgery, 2019
The cleft lip and palate (CLP) is the most common craniofacial anomalies with varying incidence from 1:500 to 1:2500 live births. (1) The etiology of cleft palate is not clear yet but it may have some hereditary, genetic factors, or gene-environment interaction. (2) Unilateral clefts are nine times as common as bilateral clefts, and occur twice as frequently on the left than the right. The ratio of left:right:bilateral clefts are 6:3:1. Males are predominantly affected by cleft lip with or without cleft palate (M: F-2:1) whereas females are more commonly affected by isolated cleft palate. (3) The complete unilateral cleft lip and palate (CUCLP) deformity is characterized by a combined maxillary and nasolabial deformity. The maxillary deformity is represented with a wide cleft gap, malaligned rotated maxillary segments, protruded and laterally displaced greater segment and collapsed lesser segment. While the nasolabial deformity is represented as; widely separated lip segments, concave ala at the cleft side of the nose, wide nostril base, deviated short columella, depressed nasal dome, and deviated nasal septum to the noncleft side with a shift of the nasal base. (4) Since, the basic aim of treatment in cleft patients is to restore normal anatomy and function, the management of cleft patients is a multidisciplinary approach. A team of experienced pedodontists, prosthodontists, maxillofacial and plastic surgeons, orthodontists, psychologist and speech therapist are necessary for the proper cleft individual management since birth to adulthood. (5)
Modern Plastic Surgery, 2013
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 mm in 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.
Journal of Maxillofacial and Oral Surgery
Presurgical orthopedics in one or the other form has been an important part of the multidisciplinary approach towards the better cleft care. Presurgical nasoalveolar molding (PNAM) was described as a modified approach to the conventional form of orthopedics. PNAM not only reduces the severity of the alveolar defect before surgery, it also reduces the nasal deformity bringing it near to the normal. Nonsurgical nasal correction forms an important adjunct to the primary nasal repair at the time of primary lip repair. However, acceptance of nasoalveolar molding in Indian set-up has not been wide spread due to various reasons such as lack of the resources and inability of the parents to comply with the frequent adjustment schedule. At the Nitte Meenakshi Institute of Craniofacial surgery at the Nitte University, Mangalore, authors have developed a modification of the PNAM appliance previously described in the literature. The key modification is done at the time of fabrication of the occlusal prosthesis. This modification has made the overall procedure simpler and at the same time helped to reduce the recall visits by half of the originally required. This article describes the fabrication procedure of the modified nasal alveolar molding appliance and the modified treatment protocol in a stepwise manner.
Abstract: 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. Timely 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.
Presurgical Nasoalveolar Molding (PNAM) for a Unilateral Cleft Lip and Palate: A Clinical Report
Journal of Prosthodontics, 2013
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.
Presurgical nasoalveolar moulding in unilateral cleft lip and palate
Indian Journal of Plastic Surgery, 2016
Context: Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. Aims: The study was conducted to evaluate the effi cacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Settings and Design: Prospective study. Subjects and Methods: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducte...