MPS  Vol.3 No.1 , January 2013
Presurgical Nasoalveolar Moulding—An Adjunct to Facilitate Surgical Repair in Infants with Cleft Lip and Palate
Abstract: Presurgical orthopedics forms an integral part of the treatment of patients with facial clefting. 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. It also helps in reducing the nasal deformity with a nasal stent which brings the deformity near to the normal and forms an important part of the primary nasal repair at the time of primary lip repair. A soft acrylic relining material is added or removed to line the appliance to a thickness of approximately 1 - 1.5 mmin the region from where the bone is to be resorbed or apposed. This article describes the fabrication procedure of the modified nasal alveolar molding appliance in eight infants with unilateral cleft lip and palate in whom a significant reduction in cleft width and nasoalveolar deformity was achieved. The results showed that the greater segment shows more favourable changes and can be molded more positively and efficiently than the lesser segment.
Cite this paper: D. Patel, R. Goyal and T. Puri, "Presurgical Nasoalveolar Moulding—An Adjunct to Facilitate Surgical Repair in Infants with Cleft Lip and Palate," Modern Plastic Surgery, Vol. 3 No. 1, 2013, pp. 34-42. doi: 10.4236/mps.2013.31007.

[1]   B. H. Grayson and C. B. Cutting, “Presurgical Nasoalveolar Orthopedic Molding in Primary Correction of the Nose, Lip, and Alveolus of Infants Born with Unilateral and Bilateral Clefts,” The Cleft Palate-Craniofacial Journal, Vol. 38, No. 3, 2001, pp. 193-198. HUdoi:10.1597/1545-1569(2001)038<0193:PNOMIP>2.0.CO;2U

[2]   C. Lee, B. H. Grayson, W. Y. Lin and C. B. Cutting, “Long Term Study of Midface Growth in Unilateral Cleft Lip and Palate Patients Following Gingivoperiosteoplasty,” American Cleft Palate Craniofacial Association, Chapel Hill, 1999.

[3]   J. M. Converse, V. M. Hogan and F. E. Borton, “Secondary Deformities of Cleft Lip, Cleft Lip and Nose, and Cleft Palate,” In: J. M. Converse, Ed., Reconstructive Plastic Surgery, Saunders, Philadelphia, 1977.

[4]   R. D. Bennum, C. Perandones, V. A. Sepliarsky, S. N. Chantiri, M. I. Aguirre and P. L. Dogliotti, “Nonsurgical Correction of Nasal Deformity in Unilateral Complete Cleft Lip: A Six-Year Follow-up,” Plastic & Reconstructive Surgery, Vol. 104, No. 3, 1999, pp. 616-630. HUdoi:10.1097/00006534-199909030-00002U

[5]   K. Matsuo, T. Hirose, T. Otagiri and N. Norose, “Repair of Cleft Lip with Nonsurgical Correction of Nasal Deformity in the Early Neonatal Period,” Plastic & Reconstructive Surgery, Vol. 83, No. 1, 1989, pp. 25-31. HUdoi:10.1097/00006534-198901000-00006U

[6]   K. Matsuo and T. Hirose, “Preoperative Non-Surgical Over-Correction of Cleft Lip Nasal Deformity,” British Journal of Plastic Surgery, Vol. 44, No. 1, 1991, pp. 5-11. HUdoi:10.1016/0007-1226(91)90168-JU

[7]   A. Bajaj, K. S. Rao, S. M. Sharma and V. Shetty, “Modified Presurgical Nasoalveolar Molding in the Infants with Complete Unilateral Cleft Lip and Palate: A Stepwise Approach,” Journal of Maxillofacial and Oral Surgery, Vol. 10, No. 3, 2011, pp. 275-280. HUdoi:10.1007/s12663-011-0232-yU

[8]   M. Hotz, “Pre- and Early Postoperative Growth-Guidance in Cleft Lip and Palate Cases by Maxillary Orthopedics (an Alternative Procedure to Primary Bone Grafting),” The Cleft Palate Journal, Vol. 6, 1969, pp. 368-372.

[9]   B. H. Grayson, P. E. Santiago, L. E. Brecht and C. B. Cutting, “Presurgical Nasoalveolar Molding in Infants with Cleft Lip and Palate,” The Cleft Palate-Craniofacial Journal, Vol. 36, No. 6, 1999, pp. 486-498. HUdoi:10.1597/1545-1569(1999)036<0486:PNMIIW>2.3.CO;2U

[10]   B. C. Pai, E. W. Ko, C. S. Huang and E. J. Liou, “Symmetry of the Nose after Presurgical Nasoalveolar Molding in Infants with Unilateral Cleft Lip and Palate: A Preliminary Study,” The Cleft Palate-Craniofacial Journal, Vol. 42, No. 6, 2005, pp. 658-663. HUdoi:10.1597/04-126.1U

[11]   D. Patel and R. Goyal, “Pre-Surgical Nasoalveolar Moulding in Patientwith Unilateral Cleft of Lip, Alveolus and Palate: Case Report,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 65, No. 1, 2012, pp. 122-126. HUdoi:10.1016/j.bjps.2011.06.011U