A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding (original) (raw)
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Journal of Pediatrics Review, 2020
Context: One of the main types of nasal deformity is the unilateral cleft lip or palate, which affects breathing and smelling. It is supposed that nasoalveolar molding (NAM) has a positive effect on the reduction of the tension in lips and helps to simplify or even eliminate the subsequent orthodontic treatment. Objective: This systematic review of papers focused on the effectiveness of NAM in patients with unilateral cleft lip or palate. Data Sources: The databases of Google Scholar, PubMed, Web of Science, and Medline were searched. Study Selection: A total of 1282 relevant articles published up to 2018 were identified. The selected papers were screened based on the eligibility criteria after the thorough investigation of their titles and abstracts. In the next step, the inconsistent articles with our objectives were removed. Afterward, the papers were thoroughly studied, and data related to our study goals were extracted and recorded in predetermined extraction forms. After the full-text evaluation of the articles, 22 articles were finally selected. Data Extraction: The search process was performed with the following keywords in combination with nasoalveolar molding or pre-surgical nasoalveolar molding or pre-surgical orthopedic appliances: "unilateral cleft lip or palate", "UCL/P", "Cleft lip", "Cleft palate". Results: Based on the literature, many studies have supported the effectiveness of NAM appliance therapy on nasal symmetry in the unilateral cleft of the lip and or palate treatment. Conclusions: The NAM therapy is effective in decreasing the severity of the initial cleft deformity, as well as repositioning of deformed nasal cartilage and alveolar process. It has many beneficial results in surgical outcomes. However, the long-term effect of this approach has remained unclear.
Plastic and reconstructive surgery, 2009
Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry. A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip-cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry. All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated ...
Plastic and Reconstructive Surgery, 2004
The purpose of this study was to assess the progressive changes of nasal symmetry, growth, and relapse after presurgical nasoalveolar molding and primary cheiloplasty in unilateral complete cleft lip/palate infants. Twenty-five consecutive complete unilateral cleft lip/palate infants were included. All the infants underwent nasoalveolar molding before primary cheiloplasty. Standard 1:1 ratio basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Linear measurements were made directly on the photographs. The results of this study revealed that the nasal asymmetry was significantly improved after nasoalveolar molding and was further corrected to symmetry after primary cheiloplasty. After the primary cheiloplasty, the nasal asymmetry significantly relapsed in the first year postoperatively and then remained stable and well afterward. The relapse was the result of a significant differential growth between the cleft and noncleft sides in the first year postoperatively. To compensate for relapse and differential growth, the authors recommend (1) narrowing down the alveolar cleft as well as possible by nasoalveolar molding, (2) overcorrecting the nasal vertical dimension surgically, and (3) maintaining the surgical results using a nasal conformer. (Plast.
Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity
Saudi medical journal, 2018
To evaluate the effectiveness of pre-surgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip nasal deformities. Methods: This was a retrospective study involving 29 patients with unilateral cleft lip and palate defects, of whom 13 were treated with palatal devices with nasal stents (PNAM group) and 16 were treated with palatal devices without nasal stents or surgical tapes (control group). Submental oblique photographs and orthodontic models were longitudinally obtained at the initial visit (T1) and immediately before (T2) and after cheiloplasty (T3). Asymmetry of the external nose, degree of columellar shifting, nasal tip/ala nose ratio, nasal base angle, interalveolar gap, and the sagittal difference in the alveolar gap were measured. The study was conducted in the Orthodontic Clinic at Tokushima University Hospital, Tokushima, Japan between 1997 and 2012. Results: At T1, there were no significant intergroup differences in the first 4 asymmetry parameters. At T...
Nasal Changes After Presurgical Nasoalveolar Molding (PNAM) in the Unilateral Cleft Lip Nose
The Cleft Palate-Craniofacial Journal, 2012
Purpose: 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 twodimensional nasal changes before and after PNAM in patients with complete UCLP.
The Cleft Palate-Craniofacial Journal, 2005
Objective To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM). Sample and Methods Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T1), before cheiloplasty (T2), 1 month after cheiloplasty (T3), and 1 year of age (T4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella—nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side. Results Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T1 to T4. The nostril height ratio was 0.5, 0.8, 1.0, and 0.9 fo...
Plastic and Reconstructive Surgery - Global Open, 2018
Background: Midface symmetry is an important indicator of success of complete unilateral cleft lip and palate (CUCLP) treatment. There is little literature on the long-term effects of presurgical nasoalveolar molding (PNAM) on midface symmetry in children treated for CUCLP. This study aimed to compare children with CUCLP who underwent PNAM before surgical interventions, children who did not receive PNAM, and age- and sex-matched controls in terms of midface symmetry. Methods: We evaluated 39 frontal facial photographs of 13 patients with CUCLP who underwent PNAM as part of the treatment (group 1: PNAM), 13 patient with CUCLP who did not undergo PNAM (group 2: no nasoalveolar molding), and 13 age- and sex-matched controls. The children were evaluated in their fifth year of life. Three midline and 3 bilateral orthopometric midface landmarks were programmed using a custom software (OnyxCeph3, Image Instruments GmbH, Germany), and corresponding linear measurements from the midline were ...
Journal of the Korean Association of Oral and Maxillofacial Surgeons, 2021
Objectives: Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. Materials and Methods: Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre-and postoperative extraoral and intraoral measurements were recorded. Results: Groups A and B did not differ significantly in any extraoral or intraoral parameter. Conclusion: The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in complete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
Journal of Cranio-Maxillofacial Surgery, 2006
The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty. Patient and method: Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery. Conclusion: Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.