Presurgical nasoalveolar moulding treatment in cleft lip and palate patients
15 January 2020 (online)
Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. The nasolaveolar molding (NAM) technique a new approach to presurgical infant orthopedics developed by Grayson reduces the severity of the initial cleft alveolar and nasal deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This paper will discuss the appliance design, clinical management and biomechanical principles of nasolaveolar molding therapy. Long term studies on NAM therapy indicate better lip and nasal form, reduced oronasal fistula and labial deformities, 60 % reduction in the need for secondary alveolar bone grafting. No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs. With proper training and clinical skills NAM has demonstrated tremendous benefit to the cleft patients as well as to the surgeon performing the repair.
- 1 Millard D. Cleft craft: The evolution of its surgery. Bilateral and rare deformities. 2nd ed. Boston: Little Brown; 1977.
- 2 Goldwyn RM. Hullihen SP. Pioneer oral and plastic surgeon. Plast Reconstr Surg 1973;52:250-7.
- 3 Millard DR Jr. Cleft craft. The evolution of its surgery. Boston: Little Brown; 1980.
- 4 Brophy TW. Cleft lip and cleft palate. J Am Dent Assoc 1927;14:1108.
- 5 McNeil C. Orthodontic procedures in the treatment of congenital cleft palate. Dent Records 1950;70:126-32.
- 6 Burston WR. The early orthodontic treatment of cleft palate conditions. Dent Pract 1958;9:41.
- 7 Georgiade NG, Latham RA. Maxillary arch alignment in the bilateral cleft lip and palate infant, using pinned coaxial screw appliance. Plast Reconstr Surg 1975;56:52-60.
- 8 Hotz M, Perko M, Gnoinski W. Early orthopaedic stabilization of the premaxilla in complete bilateral cleft lip and palate in combination with the Celesnik lip repair. Scand J Plast Reconstr Surg Hand Surg 1987;21:45-51.
- 9 Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft-lip and palate. Plast Reconstr Surg 1993;92:1422-3.
- 10 Matsuo K, Hirose T. Nonsurgical correction of cleft lip nasal deformity in the early neonate. Ann Acad Med Singapore 1988;17:358-65.
- 11 Matsuo K, Hirose T, Otagiri T, Norose N. Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period. Plast Reconstr Surg 1989;83:25-31.
- 12 Matsuo K, Hirose T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 1991;44:5-11.
- 13 Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar moulding in infants with cleft lip and palate. Cleft Palate-Craniofac J 1999;36:486-98.
- 14 Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic moulding 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.
- 15 Grayson BH, Maull D. Nasoalveolar moulding for infants born with clefts of the lip, alveolus and palate. Clin Plast Surg 2004;31:149.
- 16 Cutting CB, Bardach J, Pang R. A comparative study of the skin envelope of the unilateral cleft lip nose subsequent to rotation- advancement and triangular flap lip repairs. Plast Reconstr Surg 1989;84:409-17.
- 17 Cutting C, Grayson B. The prolabial unwinding flap method for one-stage repair of bilateral cleft-lip, nose and alveolus. Plast Reconstr Surg 1993;91:37-47.
- 18 Cutting C, Grayson B, Brecht L. Columellar elongation in bilateral cleft lip. Plast Reconstr Surg 1998;102:1761-2.
- 19 Maull DJ, Grayson BH, Cutting CB, Brecht LL, Bookstein FL, Khorrambadi D, et al. Long-term effects of nasoalveolar moulding on three-dimensional nasal shape in unilateral clefts. Cleft Palate-Craniofac J 1999;36:391-7.
- 20 Sato Y, Grayson BH, Cutting CB, Unilateral cleft lip and palate patients following gingivoperiosteoplasty. San Diego: American Association of Orthodontist; 1999.
- 21 Lee C, Grayson BH, Cutting CB. The effect of Gingivoperiosteoplasty on the outcome of secondary alveolar bone graft. Seattle: American Cleft Palate-Craniofac Assoc; 2002.
- 22 Santiago PE, Grayson BH, Cutting CB, Gianoutsos MP, Brecht LE, Kwon SM. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty. Cleft Palate-Craniofac J 1998;35:77-80.
- 23 Pfeifer TM, Grayson BH, Cutting CB. Nasoalveolar moulding and gingivoperiosteoplasty versus alveolar bone graft: An outcome analysis of costs in the treatment of unilateral cleft alveolus. Cleft Palate-Craniofac J 2002;39:26-9.
- 24 Lee CT, Grayson BH, Cutting CB, Brecht LE, Lin WY. Prepubertal midface growth in unilateral cleft lip and palate following alveolar moulding and gingivoperiosteoplasty. Cleft Palate-Craniofac J 2004;41:375-80.