Correction of Unilateral Cleft Lip Using Surgeon-Made Nasoalveolar Molding Device

ABSTRACT

The unilateral cleft of the lip and palate is a very complex deformity. This deformity comprises wide separation of the lip, defect of the ipsilateral columella and distorted nose, wide interalveolar gap due to accompanying alveolar cleft and displacement of the premaxilla. These variable deformities must be treated at the appropriate time. If not, it would result in severe facial mutilation, growth disturbance of the maxilla and functional defect of the teeth. Its ideal correction involves alignment of the dental arch, creation of a growing platform for the lip and nose, joining of the separated lip and correction of the distorted nose. Since McNeil(1950), variable presurgical orthopedic techniques have been evolved by many authors, but there is no uniform consensus. One commonly used appliance consists of an alveolar molding plate made of a hard outer shell and a soft acrylic lining described by Gnoinski. The author treated unilateral cleft lip and palate using presurgical nasal and alveolar molding (NAM) device which was introduced in 1993 by Grayson. In our cases (n=17), the author made the device by himself and performed presurgical nasoalveolar molding for the unilateral cleft lip and palate patients. Presurgical NAM device was applied in the second week following birth, and nasal stent for nasal cartilage molding was applied during nasoalveolar molding process around 6weeks after birth. Presurgical NAM was continued until repositioning of the nasal cartilages and alveolar processes (interalveolar gap <2mm), and lengthning of the deficient columella (mean vertical height of columella in postop 3 months preop. 1.5mm--> postop 4.5mm). The primary lip-nose repair and gingivoperiosteoplasty were performed within 6months after birth (mean age 17 weeks). Even though not evaluating the long term follow-up study in our cases, this technique enables a one-stage repair of the lip, nose and alveolus while the three-stage repair was necessary previously primary lip repair, secondary rhinoplasty and alveolar repair with bone graft. In addition, when presurgical nasoalveolar molding is performed by a surgeon, it can be avoided complications such as meganostril and delaying of operation time. But orthodontic postoperative care should be planned after operation for unilateral cleft lip and palate patient.