Presurgical nasoalveolar moulding treatment in cleft lip and. Nasoalveolar molding nam is a presurgical infant orthopedics technique that reduces the severity of the cleft and nasal deformity before the lip and palate surgery. 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. Matsuo6 was the first researcher who described presurgical molding of the nasal cartilage in cleft neonates. An appraisal of the nam literature will be offered.
Pdf nasoalveolar molding graysons technique semantic scholar. Case report presurgical nasoalveolar molding techniques for a. Nasoalveolar molding in early management of cleft lip and palate. Presurgical nasoalveolar molding in a 4dayold infant with. Pdf modified presurgical nasoalveolar molding in the. Longterm treatment outcome of presurgical nasoalveolar molding in patients with unilateral cleft lip and palate. Treatment ideally involves a multidisciplinary team, with the aim of restoring normal form and function. Introduction to nasoalveolar molding and presurgical columella elongation. Grayson and cutting in 1988 combined the concept of presurgical orthopedics and presurgical treatment of the cleft lip nasal deformity and developed the concepts of presurgical nasoalveolar molding pnam, which combined a nasal molding stent with a passive, presurgical molding appliance in treating cleft lip and palate in infants. The nasoalveolar molding nam technique was developed in order to provide pre surgical correction of nasal deformities for both uclp and bclp as an advance on use of the conventional pre surgical orthopedics cpso 58, largely limited to reduction of lip and alveolar clefts. Treating cleft palate with presurgical nasoalveolar molding. Presurgical orthopedics forms an integral part of the treatment of patients with facial clefting.
One of the problems that the traditional approach failed to address was 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. Nasoalveolar molding represents a paradigm shift from the traditional methods of presurgical infant orthopedics. Presurgical neonatal nasal remodeling with an infant plate was first described by dogliotti et al. Comparison of shortterm effects of presurgical nasoalveolar molding and hotzs plate on maxillary arch form in. Presurgical nasoalveolar molding therapy in patients with. An initial nasoalveolar molding appliance was created based on the patients. Cleft lip and cleft palate are among the most common birth defects. This technique facilitates the primary surgical repair of the nose and lip to heal under minimal tension, thereby reducing scar formation and improving the esthetic result. Case report presurgical nasoalveolar molding techniques. A cleft lip picture 1 is the result of the lip not fusing joining together. Cad presurgical nasoalveolar molding effects on the. The nasoalveolar molding nam technique is a new approach to presurgical infant orthopedics that reduces the severity of the initial cleft alveolar and nasal deformity. In passive molding, a custommade molding plate of acrylic is used to gently direct the growth of the alveolus to get the desired result later on.
Presurgical nasoalveolar molding for correction of cleft. Presurgical nasoalveolar remodeling an experience in the. Pour impression, with care that cleft area and frenum attachments are included. All patients were subjected to nam before the cleft lip repair.
Presurgical nam works on the principle of negative sculpturing and passive molding of the alveolus and adjacent soft tissues. Presurgical nasoalveolar molding pnam is a nonsurgical method of reshaping the gums, lips and nostrils previous to. Journal of oral and maxillofacial surgery, medicine, and pathology. Presurgical nasoalveolar mouldingan adjunct to facilitate. Prospectively, 17 infants with unilateral complete cleft lip and palate underwent the authors protocol before primary cheiloplasty. Introduction a four day old male infant was referred to our department. At our center we aimed to use pnam to help in providing the surgical team with a better foundation for an easier and more esthetic single stage repair at the. Presurgical nasoalveolar molding pnam is a presurgical infant orthopedic procedure that attempts to target the nasal deformity leading to a more esthetic surgical repair. Cleft lip and palate is a common congenital craniofacial defect. Clinical application of customized presurgical nasoalveolar molding. A case report sounder raj k 1, rachana srivastava 1, satyam gaur 1 and tuhina ghosh 2.
Presurgical orthopedics in one or the other form has been an important part of the multidisciplinary approach towards the better cleft care. Nasoalveolar molding can be a useful, costeffective adjunct for treatment of cleft lip nasal deformity. Garfinkle et al 2019 conducted a study to compare the nasal morphology of patients treated with presurgical nasoalveolar molding. Presurgical nasoalveolar molding pnam was described as a modified approach to the conventional form of. Surgical repair alone cannot correct the multiple problems encountered with the deformities that result from clefts of the lip and palate. Nasoalveolar molding, cleft lip and palate, presurgical orthopedics, and nasal stent. Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar orthopedic molding in primary. To establish a new method of presurgical nasoalveolar molding nam using computeraided reverse engineering and rapid prototyping technique in infants with unilateral cleft lip and palate uclp. Aug 29, 2017 limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry.
The purpose of this article was to present a modified protocol and devices of presurgical nasoalveolar molding techniques to improve deformity of lip, nose and alveolus at department of orthodontic, khon kaen university kku. Nasoalveolar molding nam procedure nasoalveolar molding nam cleft lip and palate. Nasoalveolar molding nam cleft lip and palate surgery. Presurgical nasoalveolar moulding treatment in cleft lip and palate.
Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. It also helps in reducing the nasal deformity with a nasal stent. Shetye institute of reconstructive plastic surgery, new york university langone medical center, new york, usa address for correspondence. Presurgical nasoalveolar mouldingan adjunct to facilitate surgical repair in infants with cleft lip and palate 35 alveolus, there is a deviation of nasal tip from the facial midline and a deformed nasal dome with significant flat.
Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry. Presurgical nasoalveolar molding for correction of cleft lip. Pnam pre naso alveolar molding linkedin slideshare. Pdf nasoalveolar molding graysons technique semantic. On stone model, block undercuts of cleft area with wonderfill or wax to allow for fabrication of maxillary plate. Presurgical nasoalveolar molding may be successfully employed in the early management of both the unilateral and bilateral cleft anomalies in newborns. Nam was developed not only to correct deviated alveolar segments but. In addition, the aim was to decrease the width of the alar base of the affected side and approximate the lip segments by placing an adhesive tape across the upper lip segments. This video describes nasoalveolar molding nam therapy, a treatment offered by orthodontists at seattle childrens hospital for infants with cleft lip. The presurgical nasoalveolar molding pnam technique, developed by grayson, is a new approach to presurgical infant orthopedics.
This presurgical management of the infants cleft is intended to reduce severity of the oronasal mouth and nose deformity prior to cleft lip and palate surgery. Nasoalveolar molding treatment in presurgical infant. The background of presurgical nasoalveolar orthopedic molding, the technique, and the literature are presented. Nasoalveolar molding treatment in presurgical infant orthopedics in. The digital geometrical data were exported to print the solid model with rapid. The upper denture casts were recorded using a threedimensional laser scanner within 2 weeks after birth in uclp infants. Effect of presurgical nasoalveolar molding in unilateral. This happens during the first few months of a babys development in the womb. Dec 11, 2018 the use of presurgical orthopedic therapy is widespread. A technical note with case report dubey rk, gupta dk, chandraker nk. Grayson bh, cutting cb 2001 presurgical nasoalveolar orthopaedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts.
Full text presurgical cleft lip and palate orthopedics. These new techniques greatly improve upon the results usually achieved through traditional cleft palate appliances. Laxmikanth, trupti karagi, anjana shetty, sushruth shetty department of orthodontics and dentofacial orthopaedics, aecs maaruti college of dental sciences and research centre, bengaluru, karnataka, india abstract cleft lip and palate clp is the most common congenital defect of the oral cavity. Mar 25, 2015 nasoalveolar molding of bilateral cleft of the lip and palate infants with orthopaedic ring plate. Nasoalveolar molding for infants born with clefts of the. The nasolaveolar molding nam technique a new approach to presurgical infant orthopedics developed by grayson reduces the severity of the initial cleft. Nasoalveolar molding got popularised because of its enabled nasal molding capability. Presurgical nasoalveolar molding sunrise orthodontics.
This new protocol was developed in order to address nasal problems as early as possible with a new extraoral type of nasal. Presurgical nasoalveolar molding in a 4dayold infant. The effects of presurgical nasoalveolar molding on the midfa. Infants mother complained of an opening over lip and difficulty in feeding and desires to get it corrected. Surgery is performed after the molding is complete, approximately three to six months after birth. The objective of the presurgical nam is to reduce the severity of the original cleft deformity and thereby enable the surgeon to achieve better repair of the alveolus, lip and nose. Apos trends in orthodontics presurgical nasoalveolar. The nam process actually expands tissues prior to surgery. The nasoalveolar moulding appliance nam consists of an intraoral moulding plate with nasal stents to mould the alveolar ridge and nasal cartilage concurrently. The goals of presurgical nasoalveolar molding nam are to align and approximate the intraoral alveolar segments and to correct the deformed cleft lower lateral cartilage. Nasoalveolar molding of bilateral cleft of the lip and palate infants with orthopaedic ring plate.
Management of effect of presurgical nasoalveolar molding on alveolar cleft. Presurgical nasoalveolar moulding treatment in cleft lip. On clinical examination patient showed complete unilateral cleft lip, alveolus and palate deformity towards the left side. Indications and contraindications for application of nam technique. We evaluated 39 frontal facial photographs of patients with cuclp who underwent pnam as part of the treatment group 1. In the united states and canada, 71% of centers reported using some form of presurgical molding before bilateral cleft lip surgery, with nasoalveolar molding being the most popular at 55% of those using this treatment. Comparison of shortterm effects of presurgical nasoalveolar. The efficient surgical repair of the cleft lip and palate is largely dependent upon the presurgical naso alveolar moulding pnam therapy that has eventually. Treating cleft palate with presurgical nasoalveolar. The effects of presurgical nasoalveolar molding on the.
During the first three months of life the surgical treatment of clp usually involves infant orthopaedics, such as presurgical nasoalveolar molding. The authors present a novel nasoalveolar molding protocol by prefabricating sets of nasoalveolar molding appliances using threedimensional technology. Presurgical nasoalveolar molding pnam was introduced to reshape the alveolar and nasal segments prior to surgical repair. Apr 07, 2020 all of these patients had no presurgical nasoalveolar molding, and these were operated by same team of surgeons using the similar technique of repair with no primary nasal correction. Presurgical nasoalveolar molding pnam for a unilateral. Effects of nasoalveolar molding therapy on nasal and alveolar. Nasoalveolar molding for infants born with clefts of the lip. The use of presurgical orthopedic therapy is widespread. Effects of nasoalveolar molding therapy on nasal and.
Keywords columella elongation, molding plate therapy, nasal cartilage, nasoalveolar molding, presurgical infant orthopedics references anderl, h. Nasoalveolar molding treatment protocol in patients with. Newborn babies born with a cleft lip and cleft palate can undergo nasoalveolar molding nam, a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and cleft palate surgery. Nasoalveolar molding nam is a pre surgical treatment used to improve the final results of surgical repair for cleft lip and cleft palate. Presurgical nasoalveolar moulding treatment in cleft lip and palate patients barry h. Presurgical naso alveolar molding free download as powerpoint presentation.
Comparative outcomes of two nasoalveolar molding techniques for bilateral cleft nose deformity. This is the most commonly used nam appliance figure 3. All of these patients had no presurgical nasoalveolar molding, and these were operated by same team of surgeons using the similar technique of repair with no primary nasal correction. Presurgical nasoalveolar molding for cleft lip and palate. Methods on the initial visit, lip taping using 14inch 3m steristrip was applied and.
Presurgical nasoalveolar moulding an adjunct to facilitate. The first treatment protocol for nasoalveolar molding nam was described and popularized by grayson et al. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar moulding in cleft lip and palate patient. The question of use of presurgical nasoalveolar molding pnam treatment for patients with cleft lip and palate clp remains an unanswered dispute. A digital model was constructed and analyzed to simulate the nam procedure with reverse engineering software. Pnam is a non surgical method of reshaping the gums, lips and nostrils before cleft lip and palate surgery, thus lessening the severity of the cleft. Nam is an adjunctive treatment to aid primary surgical reconstruction. Presurgical nasoalveolar molding technique there are numerous claims that treatment of cleft lip and palate during neonatal life needs presurgical orthopedic treatment and surgical correction of clefts. Presurgical nasoalveolar molding pnam represents a paradigm shift from the traditional methods of presurgical infant orthopedics. The stent provides support and gives shape to the nasal dome and alar cartilages. Before introduction of concept of nasoalveolar molding, repair of a large cleft required multiple surgeries between birth and 18 years of age, putting the child. The proposed benefits of treatment from the traditional techniques of presurgical orthopedics have been shown to be unsubstantiated kuijpersjagtman and prahl, 1996. A novel technique for presurgical nasoalveolar molding using.
The principle of nam is based on the breakdown of the intercellular matrix of nasal cartilage due to the abundance of hyaluronic acid during infants first 68 weeks. Along with the fabrication and use of the nasoalveolar molding appliance, there will be discussion of the surgical method that is closely associated with presurgical nasoalveolar molding. Presurgical orthopedic therapy for cleft lip and palate. Pdf presurgical nasoalveolar moulding treatment in cleft. Simultaneous repair of lip and nose in the unilateral cleft a longterm report. Presurgical nasoalveolar moulding in cleft lip and palate. Five infants 2 males and 3 females with mean age of 1.