Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate.

BACKGROUND: The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS: Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS: At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS: In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding.

Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.

A Comparative Cephalometric Study of Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Bilateral Cleft Patients at Early Mixed Dentition Period.

OBJECTIVE: To evaluate and compare early maxillary growth in 2 groups of patients with repaired bilateral cleft lip and palate (BCLP) who had and had not received nasoalveolar molding (NAM) therapy in infancy. HYPOTHESIS: Nasoalveolar molding does not have any effect on maxillomandibular growth at the early mixed dentition period. DESIGN: Retrospective study. PATIENTS: The study group consisted of forty-two 7-year-old patients with BCLP-20 in the NAM group and 22 in the no-NAM group. The control group consisted of nineteen 7-year-old noncleft, normal patients. INTERVENTIONS: Nasoalveolar molding was carried out prior to surgeries in those children who were brought in within 8 weeks of birth. Children brought in later were treated without a presurgical intervention. All patients were treated with a single-stage modified Millard cheiloplasty without gingivoperiosteoplasty. Palatoplasty was done by single-stage Bardach palatoplasty with muscle repositioning. MEAN OUTCOME MEASURES: Hard tissue and dental cephalometric values measured on lateral cephalograms, recorded at 7 years of age. RESULTS: A comparison of the mean sagittal values showed a statistically significant maxillomandibular retrusion and incisor retroclination of both BCLP groups in comparison to the control group. None of the cephalometric parameters varied statistically between NAM and no-NAM groups. The maxillomandibular relation, lower face height ratio, mandibular plane, and mandibular axis angles did not show statistically significant difference between all 3 groups. CONCLUSIONS: On the basis of this study, NAM does not have any effect on maxillomandibular growth at the early mixed dentition period.

Determination of soft tissue thickness at orthodontic miniscrew placement sites using ultrasonography for customizing screw selection.

INTRODUCTION: A wide variety of factors affect the success of orthodontic miniscrews in clinical situations, including thickness of the soft tissues. Our objectives were to assess area-related and sex-related differences in the soft tissue thicknesses of the buccal attached gingiva of the maxilla and the mandible, and the palatal masticatory mucosa at common orthodontic miniscrew placement sites, and to prescribe a guideline for miniscrew selection for a predictable clinical outcome. METHODS: The sample consisted of 32 randomly selected adults in the age group of 20 to 25 years. Soft-tissue thickness of the concerned areas was measured intraorally using an A-mode ultrasound transducer probe (Biomedix Optotechnik & Devices, Bangalore, India). Independent t tests, paired t tests, and 1-way analysis of variance with Duncan post hoc tests were used for statistical analysis. RESULTS: The palatal masticatory mucosa was 2 to 3 times thicker than the corresponding buccal attached gingiva in both sexes. The thickness of the palatal masticatory mucosa in the midpalatal region was consistently less than 1 mm (range, 0.7-1 mm). The buccal attached gingiva was comparatively thicker in the maxilla than in the mandible, except for the mandibular molar regions. It also was found that the buccal attached gingiva was thicker in women in the maxillary anterior regions, whereas, the thickness was greater in the maxillary posterior regions in the men. CONCLUSIONS: Evaluating the soft tissue thicknesses before selecting an orthodontic miniscrew can help in providing a definite guide for orthodontists to select an appropriate screw in everyday clinical practice, further enhancing the predictability of miniscrew-assisted orthodontics.

Presurgical nasoalveolar moulding in unilateral cleft lip and palate.

CONTEXT: Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. AIMS: The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. SETTINGS AND DESIGN: Prospective study. SUBJECTS AND METHODS: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. STATISTICAL ANALYSIS USED: Student's t-test for paired comparisons. RESULTS: Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. CONCLUSIONS: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.

A simple mini-screw assembly for simultaneous molar uprighting and distalization--a case of adjunctive adult orthodontics.

Anchorage is a major concern in adult mutilated dentition. However, with the explosive development of Temporary Anchorage Devices (TADs) newer avenues in orthodontic treatment philosophy have opened up. Mini-screws are found to be stable during such treatments, demonstrating that they could provide absolute anchorage for tooth movement. The present article describes a simple, yet effective technique for simultaneous molar uprighting and distalization, using direct skeletal anchorage using a mini-screw supported assembly in a 38 years old male patient as part of adjunctive adult orthodontics with mutilated dentition.