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 Table of Contents  
COMMENTARY
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 105-106

Presurgical nasoalveolar molding in patients with unilateral and bilateral clefts-changing concepts and current approach


1 Department of Orthodontics, Cleft and Craniofacial Centre, Sri Ramachandra University, Chennai, Tamil Nadu, India
2 Faculty of Medicine, Cleft and Craniofacial Centre, Sri Ramachandra University, Chennai, Tamil Nadu, India

Date of Web Publication17-Aug-2015

Correspondence Address:
Dr. N K Koteswara Prasad
Department of Orthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2125.162963

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How to cite this article:
Koteswara Prasad N K, Hussain A. Presurgical nasoalveolar molding in patients with unilateral and bilateral clefts-changing concepts and current approach. J Cleft Lip Palate Craniofac Anomal 2015;2:105-6

How to cite this URL:
Koteswara Prasad N K, Hussain A. Presurgical nasoalveolar molding in patients with unilateral and bilateral clefts-changing concepts and current approach. J Cleft Lip Palate Craniofac Anomal [serial online] 2015 [cited 2021 Oct 16];2:105-6. Available from: https://www.jclpca.org/text.asp?2015/2/2/105/162963

Restoring the lip and nose to its near normal form in children with unilateral and bilateral cleft lip is no doubt a surgical challenge for the reconstructive surgeon. The aim of presurgical nasoalveolar molding (PNAM) first described by Grayson et al. [1] was to improve the outcome of the primary repair in these patients. The primary goal of PNAM in unilateral cleft lip is to align and approximate the intraoral alveolar segments along with correction of the malpositioned nasal cartilage as well as to improve the position of the nasal tip and alar base along with the philtrum and columella. [2] The goals of PNAM in bilateral cleft lip and palate are to lengthen the retracted columella and level its base as well as to align the premaxilla with lateral alveolar segments to form a normal maxillary arch. [3]

The author has reviewed publications on nasoalveolar molding (NAM) from various sources and commented on some aspects of the procedure and drawn conclusions about its impact on the overall management of the patient. There can be little doubt that a well-executed NAM aligns the lip, nose, and the alveolar segments and makes it technically easier for the surgeon to execute the lip and nose repair, particularly when the cleft is very wide. [4] However, it is difficult to conclude in the absence of reliable long-term studies, (the authors have referred to the absence of published long-term studies and outcomes following this procedure) that this procedure benefits the patient in the long haul in terms of better outcome, reduction in treatment time, hospital visits, and additional surgical procedures referred to in the article. On the contrary, there have been several studies, which are in consonance with our own experience, have shown that the shape of the nose, in particular, is unaffected in the long-term. [5],[6],[7],[8] One of the reasons for this could be the recoil of the tissues, which have been molded before the repair when subjected to realignment following surgery.

Hence, while agreeing with the fact that NAM certainly makes it easier for the surgeon to carry out the primary repair, caution is advised before drawing any conclusions on the long-term benefits of NAM on the comprehensive management of the child with cleft.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999;36:486-98.  Back to cited text no. 1
    
2.
Bardach J, Cutting CB. Anatomy of the unilateral and bilateral cleft lip and nose. In: Bardach J, Morris HL, editors. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990. p. 150-9.  Back to cited text no. 2
    
3.
Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J 2001;38:193-8.  Back to cited text no. 3
    
4.
Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 1987;24:5-77.  Back to cited text no. 4
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5.
Pope AW, Tillman K, Snyder HT. Parenting stress in infancy and psychosocial adjustment in toddlerhood: A longitudinal study of children with craniofacial anomalies. Cleft Palate Craniofac J 2005;42:556-9.  Back to cited text no. 5
    
6.
Prahl C, Prahl-Andersen B, van′t Hof MA, Kuijpers-Jagtman AM. Infant orthopedics and facial appearance: A randomized clinical trial (Dutchcleft). Cleft Palate Craniofac J 2006;43:659-64.  Back to cited text no. 6
    
7.
Russell K, Long RE Jr., Hathaway R, Daskalogiannakis J, Mercado A, Cohen M, et al. The Americleft Study: An Inter Center Study of Treatment Outcomes for Patients With Unilateral Cleft Lip and Palate Part 5. General Discussion and Conclusions. Cleft Palate Craniofac J 2011;48:265-70.  Back to cited text no. 7
    
8.
Long RE Jr, Hathaway R, Daskalogiannakis J, Mercado A, Russell K, Cohen M, et al. The Americleft study: An inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 1. Principles and study design. Cleft Palate Craniofac J 2011;48:239-43.  Back to cited text no. 8
    




 

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