Management of Prominent Premaxilla in Bilateral Cleft Lip and Alveolus

Nemes, Balázs; Fábián, Gábor; Nagy, Kornél

doi:10.1597/12-019

Cited by 11 publications

(9 citation statements)

References 27 publications

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“… To correct the nasal tip and the alar base on the affected side(s) as well as the position of the philtrum and columella. 3,9,5,6,10,11,12,13,14 At birth, there is a high level of hyaluronic acid in the infant, which begins to fall off after 6 weeks of age. 15,16,[17][18][19][20][21][22][23] The presence of hyaluronic acid in the body makes molding the tissue and bone more easy.…”

Section: Discussion Of Managementmentioning

confidence: 99%

“…The combination of nasal and alveolar presurgical infant orthopaedic molding (nasoalveolar molding) has resulted in measurable longterm benefits to the patient (Cutting et al, 1998;Santiago et al, 1998;Maull et al, 1999) and in medical economics (Pfeifer et al, 1998). 3,4,5,6,7 CLINICAL DIAGNOSIS A 2-months-14-days-old male infant reported with unilateral cleft lip and palate on the left side of face ( Figure 1). After consultation with the cleft palate team, it was decided that the patient will be treated non-surgically at the beginning with NAM appliance so as to align the nasal cartilages, columella, philtrum and alveolar segments to facilitate the surgical restoration of a child's facial features to normal configurations.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…The cleft palate team consists of surgeons, paediatric dentists, orthodontists, prosthodontists, psychologists, therapists, translators, geneticists, case managers and for some of our older patients, even makeup artists. 1,2,3,9,4,5,6,10…”

Section: Nasoalveolar Molding Teammentioning

confidence: 99%

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Case Report- Management of Unilateral CLCP Patient by Nasoalveolar Molding

Bora¹,

Chakraborty²

2017

jebmh

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Clefts of the lip and palate unfortunately are by far the most common major facial malformations in mankind. Fortunately, as a result of technical advancements in the fields of medicine and their families for treatment, much can be done and achieved for them. The orthodontist by virtue of having gained in depth knowledge of the craniofacial complex, its growth and development and expertise in tooth movement has to play a role of prime importance in making critical decisions, planning treatment and rendering care to these patients. Nasoalveolar Molding (NAM) is a tissue-expansion procedure performed by dentists prior to a surgical repair for cleft lip and palate. 1 The NAM technique allows the paediatric dentist and surgeon to mold the abnormallyformed nasal cartilage into a more optimal relationship prior to surgery. 2 The carefully-controlled tissue expansion created by the NAM allows for the creation of a more normalappearing nose at the time of surgery for the lip closure than compared to traditional treatment by secondary alveolar bone grafting. Creating a symmetrical nose from the deficient columella and deformed nasal cartilage in cleft patients is a great challenge. The lower lateral alar cartilage in patients with unilateral cleft lip and palate is depressed and concave in the alar rim. It separates from the non-cleft-side lateral alar cartilage resulting in depression and displacement of the nasal tip. The columella is shorter on the cleft side and is inclined over the cleft with the base deviated toward the non-cleft side. Presurgical nasal molding also has been introduced as an adjunctive neonatal management for preoperative correction of nasal deformities by utilising the malleability of alar cartilage shortly after birth. Grayson et al proposed the combination of presurgical orthopaedics and nasal molding as a new technique called presurgical nasoalveolar molding for approximating the alveolar cleft and improving the nasal deformities preoperatively.

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Section: Discussion Of Managementmentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

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Case Report- Management of Unilateral CLCP Patient by Nasoalveolar Molding

Bora¹,

Chakraborty²

2017

jebmh

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“…The protruding premaxilla is common in patients with complete bilateral cleft lip and palate (BCLP; Vargevik, 1983). Early intervention during the first year of life, including lip adhesion (Innis, 1961; Bishara and Olin, 1972; Seibert, 1983; Millard and Latham, 1990; Berkowitz et al, 2004; Nemes et al, 2013), nasoalveolar molding (Grayson and Cutting, 2001; Lee et al, 2008; Garfinkle et al, 2011; Grayson and Garfinkle, 2014; Broder et al, 2016; Maillard et al, 2017), or even surgical premaxillary setback (Cronin, 1957; Niranjane et al, 2014) has been described as the treatment of protruding premaxilla. However, these procedures are not always successful (Maillard et al, 2017) and there are possible complications such as dehiscence (Lim et al, 2018), heavy scars on the lip tissue (Bardach and Salyer, 1991, Witt and Hardesty, 1993; Winters and Hurwitz, 1995), or unfavorable maxillary growth (Bishara and Olin, 1972; Koh et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

An Intraoperative Rescue Procedure for the Protruding Premaxilla in the Repair of Complete Bilateral Cleft Lip: Rapid Premaxillary Molding

Chung

Sato

Chou

et al. 2020

The Cleft Palate Craniofacial Journal

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Background: Primary reconstruction of complete bilateral cleft lip and palate (BCLP) with protruding premaxilla in one-stage surgery is challenging because of the tension on muscle repair. Such patients are also common in the developing countries. For this condition, we have applied intraoperative “rapid premaxillary molding (RPM)” technique and obtained satisfactory results. Methods: We reviewed the data of patients with complete BCLP with protruding premaxilla applying intraoperative RPM including both our institution and cleft missions to developing countries in the past 20 years. Selection criteria were patients receiving either no or insufficient preoperative molding presenting with significant protruding premaxilla, had consecutive follow-ups after surgery. To perform this technique, the surgeon holds the patient’s face with both hands and compresses the protruding premaxilla with both thumbs. An intermittent but stable backward pressure is applied to the premaxilla until the segment is gradually flexible. Repeated compression is performed prior to tying the muscle sutures, at which time the premaxilla is retro-positioned and aligned with the lateral maxillary segments. Pre- and postoperative data were evaluated. Results: We have treated a total of 60 patients with complete BCLP with protruding premaxilla applying intraoperative RPM. All patients tolerated the operations and there were no major intra- and postoperative complications including lip dehiscence and vomer fracture. All of them had satisfactory results such as adequate muscle repair and symmetry of the lip and nostrils. Conclusion: The RPM is a reliable and valuable intraoperative adjunct procedure for patients with complete BCLP presenting the protrusive premaxilla.

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“…1 The presurgical orthodontic treatment offer conducive environment for the surgical and non-surgical procedures to be conducted under required conditions. 21 Orthodontist should make sure that cleft patient has proper teeth arrangement before orthognathic surgery. The technique of Le Fort I distraction osteogenesis enhances the formation of callous bone in a gap so it greatly lowers the soft tissue restriction and reduces relapse rate.…”

Section: Introductionmentioning

confidence: 99%

The combination of different orthodontic treatment protocols and surgery techniques required in the management of patients born with cleft lip and/or palate: 10 years review

Iddi

Machibya

Xiao

et al. 2018

JDHODT

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Objectives: To summarize the combination of different Orthodontic treatment protocols and different Surgery techniques required in the management of patients born with cleft lip and/or palate. Materials and methods: We searched the relevant articles from PubMed, on the web of science, EMBASE, Google scholar and manually search by using the following search terms: "Orthodontic management and cleft lip or palate", "Post orthodontic management and cleft lip or palate" "surgery techniques and cleft lip or palate" all relevant articles in English language published from 2007 to 2017 were reviewed. Abstracts and title were evaluated and full-text analysis was performed, we excluded abstracts without full articles, articles published not in English language, Case reports, and all types of review. Results: A total of 8 articles were included in the qualitative synthesis, they were of retrospective and cohort study design. Four articles1−4 assessed the surgical timing of cleft repair and favored early (mixed dentition) over late (permanent dentition) Secondary Alveolar bone grafting (SABG). The studies on postoperative orthodontic treatment5−8 and concluded that maxillary expansion and surgical advancement are generally needed for most cleft palate patients. Conclusion: Orthodontic treatment plays an integral role in the rehabilitation phase toward the preparations of alveolar bone grafting and orthognathic surgery.

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Management of Prominent Premaxilla in Bilateral Cleft Lip and Alveolus

Cited by 11 publications

References 27 publications

Case Report- Management of Unilateral CLCP Patient by Nasoalveolar Molding

Case Report- Management of Unilateral CLCP Patient by Nasoalveolar Molding

An Intraoperative Rescue Procedure for the Protruding Premaxilla in the Repair of Complete Bilateral Cleft Lip: Rapid Premaxillary Molding

The combination of different orthodontic treatment protocols and surgery techniques required in the management of patients born with cleft lip and/or palate: 10 years review

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