Dynamic Presurgical Nasal Remodeling in Patients with Unilateral and Bilateral Cleft Lip and Palate: Modification to the Original Technique

Abstract

The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate.

Primary Overcorrection of the Unilateral Cleft Nasal Deformity

“…1-3 Many authors have described excellent results using this approach. 4,5 Furthermore, the introduction of presurgical nasoalveolar molding (NAM) into the treatment protocol 6,7 improved the functional and aesthetic results dramatically by repositioning the alveolar and palatal segments, lifting the alar cartilage and lengthening the columnella on the cleft side. 8 Another important step was made when postoperative nasal splinting became a routine component of the treatment.…”

Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: A novel modified presurgical nasoalveolar molding device with retraction screw

“…The methods introduced by Dogliotti et al (Dogliotti et al, 1991;Bennun et al, 1999;Liou et al, 2004) and Benun et al (Bennun and Figueroa, 2006;Bennun and Langsam, 2009) can simultaneously correct nasolabial and palatal deformities by directly using an orthopedic palate with a nasal stent or nasal bumper, and its dynamic orthopedic force comes from activities such as breathing, swallowing, and sucking (Dogliotti et al, 1991;Bennun et al, 1999;Liou et al, 2004;Bennun and Figueroa, 2006). The appliance was relatively poorly retained, and can't rapidly or effectively retract or centralize the premaxilla.…”

“…Presurgical orthopedic appliances provide new options. Previous studies documented that presurgical nasoalveolar molding (PNAM) treatment can elongate the columella, retract the premaxilla, narrow cleft width, and improve nasolabial symmetry (Cutting et al, 1998;Grayson et al, 1999;Grayson and Cutting, 2001;Spengler et al, 2006;Liou et al, 2007;Aminpour and Tollefson, 2008;Lee et al, 2008) but its effect is limited (Hotz et al, 1987;Grayson et al, 1993;Bennun et al, 1999;Grayson et al, 1999;Grayson and Cutting, 2001;Liou et al, 2004;Grayson and Maull, 2005;Bennun and Figueroa, 2006). The centralization and retraction of the premaxilla are among the most difficult corrections to achieve.…”

Nasoalveolar molding: A review

“…They are modifi ed muscle-activated maxillary orthopedic appliance used by Suri and Tompson [19] in NAM therapy; Retnakumari et al [17] described alveolar molding appliance with expansion screw; dynamic presurgical nasal remodeling intraoral appliance designed by Bennun and Figueroa; [20] extra-oral nasal molding appliance by Doruk and Kiliç [21] and self-retentive appliance with orthodontic wire used by Singh et al [22] and Ijaz [23] in presurgical infant orthopedics.…”