Presurgical Nasoalveolar Molding for Cleft Lip and Palate. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Shen, Congcong; Yao, Caroline A.; Magee, William; Chai, Gang; Zhang, Yan
• Is Part Of: Plastic and reconstructive surgery. Volume 135:Issue 6(2015:Jun.)
• Publication Date: 2015-06
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000001286
• Languages: English
• ISSNs: 0032-1052

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>The authors present a novel nasoalveolar molding protocol by prefabricating sets of nasoalveolar molding appliances using three-dimensional technology.</p> </sec> <sec> <title>Methods:</title> <p>Prospectively, 17 infants with unilateral complete cleft lip and palate underwent the authors' protocol before primary cheiloplasty. An initial nasoalveolar molding appliance was created based on the patient's first and only in-person maxillary cast, produced from a traditional intraoral dental impression. Thereafter, each patient's molding course was simulated using computer software that aimed to narrow the alveolar gap by 1 mm each week by rotating the greater alveolar segment. A maxillary cast of each predicted molding stage was created using three-dimensional printing. Subsequent appliances were constructed in advance, based on the series of computer-generated casts. Each patient had a total three clinic visits spaced 1 month apart. Anthropometric measurements and bony segment volumes were recorded before and after treatment.</p> </sec> <sec> <title>Results:</title> <p>Alveolar cleft widths narrowed significantly (<italic>p</italic> < 0.01), soft-tissue volume of each segment expanded (<italic>p</italic> < 0.01), and the arc of the alveolus became more contiguous across the cleft (<italic>p</italic> < 0.01). One patient required a new appliance at the second visit because of bleeding and discomfort. Eleven patients had mucosal irritation and two experienced minor mucosal ulceration.</p> </sec> <sec> <title>Conclusions:</title> <p>Three-dimensional technology can precisely represent anatomic structures in pediatric clefts. Results from the authors' algorithm are equivalent to those of traditional nasoalveolar molding therapies; however, the number of required clinic visits and appliance adjustments decreased. As three-dimensional technology costs decrease, multidisciplinary teams may design customized nasoalveolar molding treatment with improved efficiency and less burden to medical staff, patients, and families.</p> </sec> <sec> <title>CLINICAL QUESTION/LEVEL OF EVIDENCE:</title> <p>Therapeutic, IV.</p> </sec> </abstract>