Comparison of Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients

Chang, Chen-Nen; Wallace, Christopher Glenn; Pai, Betty Chien-Jung; Chiu, Yu‐Ting; Hsieh, Yun-Huan; Chen, I-Ju; Liao, Yu‐Fang; Liou, Eric Jein-Wein; Chen, Philip Kuo-Ting

doi:10.1097/prs.0000000000000361

Cited by 42 publications

(53 citation statements)

References 11 publications

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“…Nasal stenting has been used for maintenance of the alar cartilage form in clefts with stenosis. 25 - 28 Matsuo et al 29 demonstrated that the auricular cartilage could be molded with permanent results if the treatment was started within the first 6 weeks of life, due to the high degree of plasticity in the cartilage of infants during that period. They attributed this finding to the high levels of hyaluronic acid, which is a component of the proteoglycan aggregate of the intercellular matrix, in the cartilage.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity

Kinouchi¹,

Horiuchi²,

Yasue³

et al. 2018

SMJ

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Objectives:To evaluate the effectiveness of pre-surgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip nasal deformities.Methods:This was a retrospective study involving 29 patients with unilateral cleft lip and palate defects, of whom 13 were treated with palatal devices with nasal stents (PNAM group) and 16 were treated with palatal devices without nasal stents or surgical tapes (control group). Submental oblique photographs and orthodontic models were longitudinally obtained at the initial visit (T1) and immediately before (T2) and after cheiloplasty (T3). Asymmetry of the external nose, degree of columellar shifting, nasal tip/ala nose ratio, nasal base angle, interalveolar gap, and the sagittal difference in the alveolar gap were measured. The study was conducted in the Orthodontic Clinic at Tokushima University Hospital, Tokushima, Japan between 1997 and 2012.Results:At T1, there were no significant intergroup differences in the first 4 asymmetry parameters. At T2, the PNAM group showed a significant improvement in all values compared to the control group. At T3, the PNAM group showed significant improvement in nasal asymmetry and columellar shifting. Model analysis showed significantly greater changes in the inter-alveolar gap and the sagittal difference of the alveolar cleft gap from T1 to T2 in the PNAM group.Conclusion:The use of PNAM is indispensable for pre-surgical orthodontic treatment at the early postnatal age.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity

Kinouchi¹,

Horiuchi²,

Yasue³

et al. 2018

SMJ

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show abstract

“…We did not segment the sutures of the viscero- and neurocranium as reported by others, 44 and we applied a force (0.7 N) that would result in mucogingival ulceration, if it was not corrected immediately. 49 Therefore, our results from the stress distribution patterns are expected to be higher than those in vivo. In particular, in the case of the scan of the newborn, a lower stress distribution can be expected, because such small structures (0.32 mm) as observed in the model are in reality supported by surrounding tissue, which would partially absorb or transmit the incoming load state.…”

Section: Discussionmentioning

confidence: 82%

Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis

Ritschl

Heinrich

Grill

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The purpose of this study was to evaluate the stress distribution patterns within the viscero- and neurocranium of neonates during nasoalveolar molding.Methods:Finite element models of 3 different healthy neonates at different times of life (date of birth, 4 weeks, and 3.5 months) were generated on the basis of computed tomography scans. A validated workflow, including segmentation, meshing, setting of boundary conditions, and implementation of a bone density–dependent material model, was carried out for each model. A small and a large unilateral alveolar and hard palatal cleft were virtually cut in each model. The stress distribution pattern in each model was then analyzed by using Ansys APDL.Results:Convergence analysis validated the results. The virtual experiments at the date of birth showed a stress pattern above a previously defined threshold value of 30,000 Pa in the ipsilateral naso-orbital-complex, frontal sinus, and the anterior fossa of the base of the skull, with von Mises values > 35,000 Pa. Stress patterns at the age of 4 weeks and 3.5 months showed reduced von Mises values at < 15,000 Pa.Conclusions:Nasoalveolar molding therapy is a safe presurgical treatment modality without significant influence on the viscero- and neurocranium of neonates. Treatment, considering the stress distribution at the naso-orbital-complex and anterior fossa of the base of the skull, should begin in the second week of life, and treatment initiation of preterm infants should be adapted respectively.

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“…Bennun and Figueroa [ 35 ] provided another modification known as dynamic presurgical nasal remodelling. Two of the selected studies assessed this last modified technique and both concluded that the Figueroa appliance (with a large nasal stent) decreases the risk of ulceration compared to the traditional (Grayson) appliance [ 58 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review

Maillard

Retrouvey

Ahmed

et al. 2017

JOMR

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ObjectivesThe authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair.Material and MethodsA literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals (“Cleft Palate-Craniofacial Journal”, “Plastic and Reconstructive Surgery Journal” and “American Journal of Orthodontics and Dentofacial Orthopaedic”) from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology.ResultsOf the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking.ConclusionsBased on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.

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Comparison of Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients

Abstract: Therapeutic, II.

Cited by 42 publications

References 11 publications

Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity

Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity

Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis

Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review

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