Three-Dimensional Nasal Changes following Nasoalveolar Molding in Patients with Unilateral Cleft Lip and Palate: Geometric Morphometrics

Singh, Gagandeep; Levy-Bercowski, Daniel; Santiago, Pedro E.

doi:10.1597/04-063.1

Cited by 105 publications

(73 citation statements)

References 22 publications

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“…They stated that in patients with cleft lip and palate with natal/neonatal teeth who require NAM, the teeth must be removed to facilitate the fabrication and placement of the device. Singh et al [20] evaluated the 3D facial morphology in patients surgically corrected for unilateral cleft lip and palate following presurgical NAM.…”

Section: Discussionmentioning

confidence: 99%

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Punga¹,

Sharma

2012

J. Maxillofac. Oral Surg.

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Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.

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Section: Discussionmentioning

confidence: 99%

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Punga¹,

Sharma

2012

J. Maxillofac. Oral Surg.

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“…Therefore, this study investigated the effect of a SPR protocol on 3-D upper airways in patients being treated for TMD. Finite element analysis has been used previously on 2-D and 3-D clinical data with acceptable results [5,11]. Similarly, PCA has also been used to validate the FESA findings [12].…”

Section: Discussionmentioning

confidence: 99%

Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD

Singh

Olmos²

2007

Sleep Breath

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Patients with temporomandibular dysfunction (TMD) require antero-posterior (AP) correction of mandibular position inter alia. Determination of the limit of the AP correction using a sibilant phoneme registration (SPR) protocol is essential in not increasing muscular tonus. The aim of this study is to investigate the effect of a SPR protocol on the upper airway. Using acoustic pharyngometry data, mean airways of 46 adults undergoing treatment for TMD were reconstructed in 3-D and analyzed using finite element analysis and principal components analysis. When the mean baseline functional residual capacity (FRC) airway was compared to the mean collapsed residual volume (RV) airway, a 25% reduction in the 3-D upper airway was demonstrable (p < 0.01). When the mean baseline FRC airway was compared to the mean airway with SPR (FRC-SPR), a 12% increase was found at the oropharyngeal junction of the 3-D airway, but this finding failed to reach statistical difference. Similarly, when the mean FRC-SPR airway was compared to the mean RV-SPR airway, the amount of collapse was reduced to 16% but again no statistical difference was found. In contrast, when the mean RV airway was compared to the mean RV-SPR airway, a 15-18% increase was found (p< 0.05). It is concluded that the use of a SPR protocol may be useful in improving upper airway RV in patients, during treatment for TMD.

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“…There are different kinds of PSIO treatment approaches with different mechanics, all seeking and achieving different objectives (Friede et al, 1998;Kuijpers-Jagtman et al, 2000;Prahl-Andersen, 2000;Ross et al, 2000;Watson et al, 2004;Berkowitz, 2006). Among these, presurgical nasoalveolar molding (PNAM) appliances have generated considerable interest in recent years and have been in use as a new approach to traditional presurgical infant orthopedics (TPSIO) Maull et al, 1999;Grayson et al, 2001;Suri and Tompson, 2004;Singh et al, 2005). Some of the major advantages of TPSIO are claimed to be the improvement of arch form, the facilitation of surgical closure, and thus improvement of aesthetic outcome, the facilitation of feeding, and improvement of speech (Ross and MacNamera, 1994;Kuijpers-Jagtman et al, 2000;Mishima et al, 2000;Prahl et al, 2001;Konst et al, 2004;Berkowitz, 2006).…”

mentioning

confidence: 99%

Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review

Uzel¹,

Alparslan

2011

The Cleft Palate Craniofacial Journal

112

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Objective: This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes.Design: A systematic review. Methods: Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had followup periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction.Results: Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances.Conclusions: Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

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Three-Dimensional Nasal Changes following Nasoalveolar Molding in Patients with Unilateral Cleft Lip and Palate: Geometric Morphometrics

Abstract: Using NAM, bilateral nasal symmetry in patients with unilateral cleft lip and palate was improved before surgical repair. Furthermore, slight overcorrection of the alar dome on the cleft side using pressure exerted by the nasal stent is indicated to maintain the NAM result.

Cited by 105 publications

References 22 publications

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD

Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review

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