Comparative Study of Presurgical Infant Orthopedics by Modified Grayson Method and Dynacleft With Nasal Elevators in Patients With Unilateral Cleft Lip and Palate—A Clinical Prospective Study

Abstract

Objective: To compare the effects of presurgical infant orthopedics using 2 different methods, that is, the Dynacleft with Nasal elevator system versus the modified Grayson’s technique in patients with complete unilateral cleft lip and palate. Design: Prospective comparative cohort study. Materials and Methods: Twenty-eight patients were divided into 2 groups, that is, Group A consisting of 14 patients who underwent correction with DynaCleft with Nasal elevator system and Group B consisting of 14 patients undergoing correction using the modified Grayson technique. Maxillary cast measurements were taken at 2-time intervals (pre- and posttreatment) to assess various parameters using a laser scanning machine (C500 Solutionix) and 3D software (GOM Inspect). Similarly, standardized anterior–posterior and worm’s-eye view photographs using a custom box were taken and imported to Adobe Photoshop CS6 for measurements. Paired t test and independent t test were used to compare intra- and intergroup changes, respectively. Results: The analysis of cast (primary outcome) and photographic (secondary outcome) measurements showed improved nasal asymmetry and alveolar correction in both groups which showed no significant intergroup difference when assessed using the independent t test ( P > .05). Group A showed higher chances (42.8%) of causing a T-shaped defect (due to excessive mesial-inward rotation of the minor segment) when compared to the Group B possibly due to a more controlled molding vector ( P < .05). Conclusion: Both methods proved effective in improving the nasal asymmetry, reducing the alveolar cleft gap, and approximating the lips together; but care must be taken when applying the alveolar molding vector in the Dynacleft system.

A New Frame for Orienting Infants With Cleft Lip and Palate During 3-Dimensional Facial Scanning

“…We used a "U"-shaped infant supporter pillow to restrict the movement of infant's head and having the parent or caretaker to be in direct visibility of the child from above the frame so that the infant will be in a comfort zone while being attentive to the parent or caretaker. The mentioned pillow has been used in our department's previous studies (Abhinav et al, 2021). As mentioned above, stabilizing infants with CLP or any other craniofacial developmental disorder is a major challenge, yet accurately recording the craniofacial structures is pertinent to document and objectively measure growth and treatment (if any) changes.…”

3D Infant Orthopedic Nasal Molding System for Improved Outcomes in Cleft Nasal Deformity

“…These have included simulating the modification of the alveolar segments, and transferring them as data sets to 3D printer devices, producing high precision, sequential palatal molding devices. 10,11,15 For the RAS, we are similarly using a nasal appliance system made with 3D technology and biomedical clear resin. The nasal devices are based on models of normal anatomy and come in 4 sizes.…”

Current Presurgical Infant Orthopedics Practices Among American Cleft Palate Association–Approved Cleft Teams in North America

“…Comparison of the DynaCleft Nasal Elevator with NAM concluded that both resulted in satisfactory nasal symmetry and reduction in the alveolar cleft gap. 39,40 However, less control of the molding vector resulting in a higher incidence of a rotated lesser alveolar segment or "T-Defect" with the DynaCleft. 40 Thus, this simpler modality is not without its drawbacks.…”

“…39,40 However, less control of the molding vector resulting in a higher incidence of a rotated lesser alveolar segment or "T-Defect" with the DynaCleft. 40 Thus, this simpler modality is not without its drawbacks.…”