To improve the esthetic and functional outcome for cleft lip and palate infants, a new approach to presurgical infant orthopedics, presurgical nasoalveolar molding (PNAM) has been developed. The goal of this method is to streamline the surgical repair process, as well as reduce the total number of surgeries required. This technique utilizes the malleability of the immature alar cartilage and its ability to maintain its corrected form, provided that intervention is timely. An acrylic appliance is fabricated chairside, and light orthopedic forces are applied to mold the alveolus to normal coutour. Additionally, the alar cartilages can be molded to normal form, allowing the definitive nasal repair to be accomplished concomitantly with the initial lip closure and gingivoperiosteoplasty.
OBJECTIVES: To quantify 1) the average amount of alveolar closure accomplished using PNAM, and 2) the efficacy of the nasal molding.
METHODS: Thirty-six infants with unilateral cleft lip and palate were included in the study. All were treated with PNAM and were followed at least through the age of 16 weeks when the initial lip closure was performed.
RESULTS: The average alveolar closure was 8.0mm. In all thirty-six cases, nasal molding allowed nasal repair at the initial surgery and columellar reconstruction was eliminated.
CONCLUSIONS: Presurgical nasoalveolar molding shows great promise in becoming the standard of care in treating infants with cleft lip and palate. The data demonstrates definitive early nasal repair, controlled presurgical reduction of the alveolar cleft, and fewer surgeries required overall.