IADR Abstract Archives
The Modified Nasoalveolar Molding Appliance for Cleft Lip/Palate Patients
Objectives: To improve esthetic results, nasal alveolar molding (NAM) reduces the severity of the cleft lip/palate (CLAP) presurgically by reshaping the alveolar, lip and nasal segments. Objectives: 1- Highlight the importance of NAM appliance before surgical lip closure, 2- Describe two new modifications of the original NAM appliance for easier manipulation and less irritation, 3- Quantify the nasolabial soft tissue changes after NAM and lip closure surgery, 4- Compare the nasolabial soft tissue changes between CLAP patients treated with and without NAM.
Methods: Two groups of 12 CLAP patients each were included: Group 1 (mean age:1.1mos±0.2) consisted of 7 bilateral and 5 unilateral CLAP patients treated with modified NAM appliances prior to surgical cleft closure; Group 2 (mean age:6mos±0.2) included 4 bilateral and 8 unilateral CLAP patients treated surgically without NAM. Measurements of soft tissue nasolabial segments on pre-NAM (T1), post-NAM (T2) and post-surgery (T3) photographs were compared.
Results: In the NAM group, cleft size was reduced by 65% in 4 to 5 months and a statistically significant (SS) difference in all measurements between all time points was found, except for columella length between T2 and T3. This accompanied significant improvement in nasal symmetry, including increase of nasal tip projection, columellar dome and nostril heights and decrease of nostril width and bialar width (by 18%). Both modified appliances achieved elongation of the philtrum of the upper lip by 28%. When comparing NAM to non-NAM users at T3, SS differences in the affected nostril height and the labial nasal tip were noted.
Conclusions: NAM therapy should be started early in life, ideally within the 1st month. The modified NAM provided easier activation of the appliance and placement by the parents and significantly reduced or eliminated skin irritation with more promising results.
Methods: Two groups of 12 CLAP patients each were included: Group 1 (mean age:1.1mos±0.2) consisted of 7 bilateral and 5 unilateral CLAP patients treated with modified NAM appliances prior to surgical cleft closure; Group 2 (mean age:6mos±0.2) included 4 bilateral and 8 unilateral CLAP patients treated surgically without NAM. Measurements of soft tissue nasolabial segments on pre-NAM (T1), post-NAM (T2) and post-surgery (T3) photographs were compared.
Results: In the NAM group, cleft size was reduced by 65% in 4 to 5 months and a statistically significant (SS) difference in all measurements between all time points was found, except for columella length between T2 and T3. This accompanied significant improvement in nasal symmetry, including increase of nasal tip projection, columellar dome and nostril heights and decrease of nostril width and bialar width (by 18%). Both modified appliances achieved elongation of the philtrum of the upper lip by 28%. When comparing NAM to non-NAM users at T3, SS differences in the affected nostril height and the labial nasal tip were noted.
Conclusions: NAM therapy should be started early in life, ideally within the 1st month. The modified NAM provided easier activation of the appliance and placement by the parents and significantly reduced or eliminated skin irritation with more promising results.