As 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.
The nasoalveolar molding (NAM) technique has been shown to significantly improve the surgical outcome of the primary repair in cleft lip and palate patients. A 6-day-old female infant was managed with the presurgical NAM technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the next 5 months. The 13 mm of alveolar cleft width was reduced to 1.5 mm. The depressed nostril on the cleft side was molded into the normal anatomy. The nose and upper lip were surgically repaired at the age of 5 months. The second stage surgery of palatal closure was performed at the age of 18 months. The patient was followed up regularly at 6-month intervals for the next 5 years.
Severe bilateral cleft-lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5-day-old male infant with bilateral cleft-lip-palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft-lip/palate cases, simple modifications in the appliance can achieve rapid results.
KeywordsUnilateral cleft lip and palate; nasal stent; extraoral retentive button; columella-philtrum.
AbstractCleft lip and palate deformity is a congenital defect of the middle third of the face.
Although surgical correction remains the mainstay of treating unilateral/bilateral cleft lip and/or palate deformities, some inadequacies still remain like scarring of the nasolabial complex, multiple interventions to achieve desired results, etc. Presurgical nasoalveolar moulding consists of selective repositioning by active moulding of the alveolar segments as well as the surrounding soft tissue. Clinical case of unilateral mid-facial cleft treated by the same, showed significant reduction in the defect size and improved contour of the columella-philtrum region for superior postsurgical esthetics.
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