Nose and Lip Morphology Changes after Presurgical Nasoalveolar Molding in Complete Unilateral Cleft Lip and Palate Patients by Direct Measurement

Main Article Content

Siriya Pattarasiriporn
Aggasit Manosudprasit
Amornrut Manosudprasit
Poonsak Pisek

Abstract

This study aimed to evaluate the changes of nose and upper lip morphology after using Khon Kaen university presurgical nasoalveolar molding (KKU PNAM) in unilateral cleft lip and palate (UCLP) patients. 12 infants with unilateral cleft lip and palate (UCLP) were treated with the modified Khon Kaen University forehead-supported presurgical nasoalveolar molding appliance. Direct measurement using a Boley gauge was done at initial visit (T1) and before cheiloplasty (T2), Starting age of treatment was 5 - 60 days and period of treatment 66 - 132 days. Measurements included: alar
base width, alar base deviation, nostril width on the cleft side, nostril height on the cleft side, columella length, columella deviation, alveolar ridge gap, vermillion gap, upper lip protrusion and nose protrusion of the patients. Paired sample T-test was used to compare the differences between pre- and post-therapy measurements. After KKU PNAM treatment, significant changes were observed in the measurements at T2 compared to T1 (p < 0.05). There were significant increases in nose protrusion, columella length and the nostril height on the cleft side. Alar base deviation, columella deviation and nostril width on the cleft side were significantly reduced. Moreover, the alveolar ridge gap, vermillion gap and upper lip protrusion were
also significantly decreased. In conclusions, Preliminary treatment of UCLP with KKU PNAM offered a significant decrease in intersegment cleft lip distance and improved nose morphology which possibly could improve the surgical outcome of cheiloplasty and nasal surgery.

Article Details

How to Cite
1.
Pattarasiriporn S, Manosudprasit A, Manosudprasit A, Pisek P. Nose and Lip Morphology Changes after Presurgical Nasoalveolar Molding in Complete Unilateral Cleft Lip and Palate Patients by Direct Measurement. Khon Kaen Dent J [Internet]. 2018 May 31 [cited 2024 Dec. 22];20(2):52-6. Available from: https://he01.tci-thaijo.org/index.php/KDJ/article/view/126313
Section
Articles
Share |

References

1. Chowchuen B, Godfrey K. Development of a network system for the care of patients with cleft lip and palate in Thailand. Scand J Plast Reconstr Surg Hand Surg 2003;37(6):325-31.
2. Hodgkinson PD, Brown S, Duncan D, Grant C, McNaughton A, Thomas P, et al. Management of children with cleft lip and palate: A review describing the application of multidisciplinary team working in this condition based upon the experiences of a regional cleft lip and palate centre in the United Kindom. Fetal Matern Med Rev 2005;16(01):1-27.
3. Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 2005;42(6):658-63.
4. Salyer KE. Early and late treatment of unilateral cleft nasal deformity. Cleft Palate Craniofac J 1992;29(6):556-69.
5. Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg 1993;92(7):1422-3.
6. Doruk C, Kilic B. Extraoral nasal molding in a newborn with unilateral cleft lip and palate: a case report. Cleft Palate Craniofac J 2005;42(6):699-702.
7. Manosudprasit M, Chongcharueyskul P, Wangsrimonkol T, Pisek P. Presurgical Nasoalveolar Molding Techniques for a Complete Unilateral Cleft Lip and Palate Infant : A Case Report. J Med Assoc Thai 2015;98(7):234-42.
8. Berggren A, Abdiu A, Marcusson A, Paulin G. The nasal alar elevator: an effective tool in the presurgical treatment of infants born with cleft lip. Plast Reconstr Surg 2005;115(6):1785-7.
9. Abdiu A, Ohannessian P, Berggren A. The nasal alar elevator: a new device that may reduce the need for primary operation of the nose in patients with cleft lip. Scand J Plast Reconstr Surg Hand Surg 2009;43(2):71-4.
10. Monasterio L, Ford A, Gutierrez C, Tastets ME, Garcia J. Comparative study of nasoalveolar molding methods: nasal elevator plus DynaCleft(R) versus NAM-Grayson in patients with complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2013;50(5):548-54.
11. Singh GD, Levy-Bercowski D, Santiago PE. Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: geometric morphometrics. Cleft Palate Craniofac J 2005;42(4):403-9.
12. Singh GD, Levy-Bercowski D, Yanez MA, Santiago PE. Three-dimensional facial morphology following surgical repair of unilateral cleft lip and palate in patients after nasoalveolar molding. Orthod Craniofac Res 2007;10(3):161-6.
13. Ezzat CF, Chavarria C, Teichgraeber JF, Chen JW, Stratmann RG, Gateno J, et al. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 2007;44(1):8-12.
14. Grayson BH, Maull D. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate. Clin Plast Surg 2004;31(2):149-58, vii.
15. Matsuo K, Hirose T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 1991;44(1):5-11.
16. Gomez DF, Donohue ST, Figueroa AA, Polley JW. Nasal changes after presurgical nasoalveolar molding (PNAM) in the unilateral cleft lip nose. Cleft Palate Craniofac J 2012;49(6):689-700.
17. Kecik D, Enacar A. Effects of nasoalveolar molding therapy on nasal and alveolar morphology in unilateral cleft lip and palate. J Craniofac Surg 2009;20(6):2075-80.
18. Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg 2004;114(4):858-64.
19. Kirbschus A, Gesch D, Heinrich A, Gedrange T. Presurgical nasoalveolar molding in patients with unilateral clefts of lip, alveolus and palate. Case study and review of the literature. J Craniomaxillofac Surg 2006;34 Suppl 2:45-8.
20. Mishra B, Singh AK, Zaidi J, Singh GK, Agrawal R, Kumar V. Presurgical nasoalveolar molding for correction of cleft lip nasal deformity: experience from northern India. Eplasty. 2010;10.
21. Grayson BH, Garfinkle JS. Early cleft management: the case for nasoalveolar molding. Am J Orthod Dentofacial Orthop 2014;145(2):134-42.
22. Hathaway RR, Long RE, Jr. Early cleft management: in search of evidence. Am J Orthod Dentofacial Orthop 2014;145(2):135-41.