Presurgical Nasoalveolar Molding in Infants with Cleft Lip and Palate

Abstract

Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of Immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center.

Presurgical Nasoalveolar Molding Orthopedic Treatment Improves the Outcome of Primary Cheiloplasty of Unilateral Complete Cleft Lip and Palate, as Assessed by Naris Morphology and Cleft Gap

“…Among the appliance used, the nasoalveolar molding (NAM) orthopedic plate developed by Grayson et al 12 is well known and has been modified by several groups. Among the appliance used, the nasoalveolar molding (NAM) orthopedic plate developed by Grayson et al 12 is well known and has been modified by several groups.…”

A bibliometric analysis of the 50 most cited papers in cleft lip and palate

“…Fistula development was first explored at this stage [40]. Many papers covered the aesthetics of the nasal area [37,58,68]. Bone grafts were still evolving using the iliac crest bone [44].…”

The Importance of Primary Rhinoplasty at the Time of Initial Unilateral Cleft Lip Repair

“…5,6 Its use is indicated in wide unilateral clefts with alveolar segment mismatch, wide bilateral clefts with a "lockedout-premaxilla," or asymmetric bilateral clefts (Figure 2). Successful use of this method requires a team approach with a dedicated orthodontist and a flexible and compliant family.…”