Pre-surgical infant orthopedics with the nasoalveolar molding (NAM) device for unilateral and bilateral cleft lip and palate: Case series

Management of infants born with cleft lip and palate entails an interdisciplinary team effort that begins from infancy to adulthood. The goal of pre-surgical infant orthopedics is to reduce the severity of the cleft deformity before surgery. However, traditional methods do not address the deformity of the nasal cartilages and alveolar ridges simultaneously. The Nasoalveolar Molding (NAM) technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. The NAM device is used to actively mold the alar dome, nasal cartilages, premaxilla, and alveolar ridges into a more normal anatomic form and position. It permits non-surgical elongation of the columella through application of tissue expansion principles. This results in better facial aesthetics and may help reduce the extent, number and cost of surgeries. The three cases presented illustrate the application of the NAM device for the pre-surgical infant orthopedics in unilateral and bilateral cleft lip and palate patients treated at the Philippine Children's Medical Center-Pediatric Dentistry Division (PCMC-PDD).

Anthropometric Analysis of Unilateral Cleft Lip Patient

Establishment of 3-dimensional finite element model of maxillary in human complete unilateral cleft lip and palate with spiral CT scan / 中南大学学报(医学版)

Objective To explore a faster and more precise method to establish a 3-dimensional (3 D) finite element model of maxillary in human complete unilateral cleft lip and palate. Methods The surface of the model was created using Materialists Interactive Medical Image Control System (Mimics) software to deal with Dicom standard files obtained by scanning the cranium of the patient with multi-slice helical CT. The 3D finite element model for complete unilateral cleft lip and plate in maxillary was established by Ansys software. Results A 3D finite element model of maxillary in human complete unilateral cleft lip and palate was constructed with 27 405 units and 26 876 nodes. Conclusion The combination of Mimics software, Geomagic studio software, Ansys software, and spiral CT is able to create a 3D finite element counter model, which provides a faster and more valid method to study complete unilateral cleft lip and palate.

Effect of presurgical nasoalveolar molding (PNAM) appliance and cheiloplasty on alveolar molding of complete unilateral cleft lip and palate patients / 대한치과교정학회지

The goal of the present study was to evaluate the effects of PNAM appliance and cheiloplasty on alveolar molding. Samples consisted of 16 unilateral cleft lip and palate infants (10 males and 6 female, mean age=37.0 days after birth, average alveolar cleft gap=10.46 mm), who were treated with PNAM appliances by one orthodontist and rotation- advancement cheiloplasty by one surgeon in Seoul National University Hospital. Average duration of alveolar molding treatment was 13.10 weeks and these patients were recalled at average 8.31 weeks after cheiloplasty. These patients' models were obtained at initial visit (T0, mean age : 37.0+/-27.89 days after birth), after successful alveolar molding (T1, mean age : 119.25+/-40.18 days after birth), and after cheilopasty (T2, mean age : 190.81+/-42.78 days after birth). Seven linear and five angular variables were measured using 1 : 1 photometry and soft ware program(V-ceph. Cybermed, Seoul, Korea). Paired t-test was performed to investigate statistical significance at p < 0.05 level. 1. The posterior parts of alveolar segments were the stable structures during alveolar molding treatment period and after cheiloplasty in infants. 2. The closure of cleft gap during alveolar molding was usually due to backward bending of the whole part of the greater segment. 3. Although forward growth of the greater segment was hindered by alveolar molding, it resumed after cheiloplasty. 4. Increase of anterior inter-segment angle after cheiloplasty was due to the molding effect of the lip scar pressuren

Diagnostic Measures in Borderline Surgical Cases of Unilateral Cleft Lip and Palate and Noncleft Class III Malocclusions

Patients with complete unilateral cleft lip and palate present difficulty in maxillary growth problems, necessitating orthognathic surgery in 25%. The aims of this study were; (1) to delineate diagnostic measures in borderline surgical cases of unilateral cleft lip and palate, (2) to verify the significance of negative overjet as a measure of anteroposterior discrepancy, and (3) to compare these diagnostic measures with those of borderline surgical cases of noncleft Class III malocclusion. The sample consisted of 29 patients with unilateral cleft lip and palate and 25 noncleft Class III patients; all had crossbites of all four incisors. Each of pretreatment study casts and cephalograms were analyzed. The Cleft group showed smaller SNA and SNB angles than the noncleft Class III group, but the ANB angles and the amount of anterior crossbites showed no statistical difference. For borderline surgical Class III unilateral cleft lip and palate cases, ANB angles, Wits appraisal, and ABGoGn angle were critical diagnostic parameters. On the other hand, the magnitude of anterior crossbite, the negative overjet, was shown not to be a significant measure of anteroposterior discrepancy.

Presurgical naso-alveolar molding appliance for unilateral cleft lip and palate / 대한치과교정학회지

The goals of this study were to present presurgical naso-alveolar molding (PNAM) appliance in unilateral cleft lip and palate treatment and to evaluate the effects of PNAM appliance on alveolar molding. Samples were consisted of 4 unilateral cleft lip and palate infants (3 males and 1 female, mean age=23.2 days after birth) who were treated with PNAM appliances in Department of Orthodontics, Seoul National University Dental Hospital. Average alveolar cleft gap between the greater and lesser segment was 8.27 mm and average duration of alveolar molding treatment was 9.7 weeks. These patients' models were obtained at initial visit (TI) and after successful alveolar molding (T2). Seven linear and five angular variables were measured by using photometry and digital caliper. All statistical analyses were performed by SPSS win ver. 7.5 program. Paired t-test was used to compare the mean values. 1. The posterior part of alveolar segments are the stable structures during alveolar molding treatment period in infants. 2. Forward growth of the greater segment may be hindered by the action of alveolar molding. 3. The closure of cleft gap during alveolar molding were usually due to inward and backward bending of the anterior part of the greater segment and outward bending of the whole lesser segment.