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Hattori Y, Pai BCJ, Saito T, Chou PY, Lu TC, Chang CS, Chen YR, Lo LJ. Outcome of Patients with Complete Cleft Lip and Alveolus: 20-Year Follow-Up. Plast Reconstr Surg 2025; 155:746e-757e. [PMID: 38991117 DOI: 10.1097/prs.0000000000011622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Patients with cleft have functional and aesthetic impairment, and typically require several interventions as they grow. Long-term evaluation following a treatment protocol is essential, but such reports on patients with complete cleft lip and alveolus (CLA) are sparse in the literature. METHODS A retrospective review was conducted of all patients with complete CLA born between January of 1995 and August of 2002 and treated at our center. Patients who received continuous multidisciplinary team care until 20 years of age were included, and patients with cleft palate and syndromic abnormalities were excluded. Facial bone growth was evaluated using cephalometric analysis. RESULTS Eighty-seven and 11 patients with unilateral and bilateral CLA, respectively, were included. All patients underwent one-stage cheiloplasty with primary rhinoplasty. Revision lip/nose surgery was performed in 21.8% and 27.3% during growing age, and in 51.7% and 72.7% after skeletal maturity, respectively. Orthognathic surgery was performed in 20.7% and 27.3%, respectively. Compared with unilateral CLA patients, bilateral CLA patients had more operations (3.0 versus 3.7; P = 0.03) and a higher chance of undergoing alveolar bone grafting twice (1.1% versus 36.4%; P < 0.01). Patients with complete CLA had less hypoplastic maxilla, and underwent fewer operations than those with complete cleft lip and palate. CONCLUSIONS Complete CLA is a less severe form of cleft, but the patients still require multiple interventions. This review revealed certain suboptimal results, and modifications have been made in the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.
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Affiliation(s)
- Yoshitsugu Hattori
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Betty Chien-Jung Pai
- Craniofacial Orthodontics
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Takafumi Saito
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Pang-Yun Chou
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
| | - Ting-Chen Lu
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Chun-Shin Chang
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Yu-Ray Chen
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
| | - Lun-Jou Lo
- From the Departments of Plastic and Reconstructive Surgery
- Craniofacial Research Center, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University
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Ruojing L, Ruizhi L, Zhuo C, Shujuan Z, Jingtao L, Xing Y. Cephalometric analyses of the correlation between nasal and maxilla morphology among adult patients with cleft. J Plast Reconstr Aesthet Surg 2025; 103:264-272. [PMID: 40022951 DOI: 10.1016/j.bjps.2025.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 12/21/2024] [Accepted: 01/24/2025] [Indexed: 03/04/2025]
Abstract
OBJECTIVE To explore if the nasal profile is influenced by maxillary hypoplasia among patients with congenital cleft lip and palate. METHODS Young adult patients with cleft and noncleft controls were enrolled. Nasal and maxillary profiles were measured on lateral cephalometric radiographs. The Kruskal-Wallis and Tukey post-hoc tests were employed for intergroup comparison among various the cleft types, and Pearson's product moment correlation coefficients were calculated to detect the correlation between nasal and maxillary cephalometric measurements. RESULTS A total of 250 participants were enrolled, including 64 with unilateral cleft lip and alveolae; 22 with bilateral cleft lip and alveolae; 49 with unilateral cleft lip, alveolae, and palate; 35 with bilateral cleft lip, alveolae, and palate; and 80 controls. Patients with cleft demonstrated significant difference in nasal and maxillary profiles when compared with the normal controls. The nasal dorsum length had a significant positive correlation with anterior and posterior maxillary height. The upper nasal dorsum length had a significant negative correlation with the maxillary protrusion. Among patients with bilateral cleft, the nasal dorsum length was also significantly negatively correlated with the maxillary protrusion. CONCLUSION The nasal profile is closely related to the growth of maxillae among patients with cleft and the normal population.
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Affiliation(s)
- Liu Ruojing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Ruizhi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chen Zhuo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zou Shujuan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Jingtao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yin Xing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Udomvanit V, Manosudprasit A, Chaichit R, Manosudprasit A. Nasolabial Morphological Changes Post-Khon Kaen University Presurgical Nasoalveolar Molding Therapy in Infants with Complete Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2025:10556656251327463. [PMID: 40101266 DOI: 10.1177/10556656251327463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025] Open
Abstract
ObjectiveTo assess the efficacy of Khon Kaen University presurgical nasoalveolar molding (KKU PNAM) by evaluating nasolabial morphological changes in patients with complete unilateral cleft lip and palate (UCLP) using three-dimensional (3D) anthropometric measurements and comparing nasal morphology to age-matched noncleft controls.DesignA retrospective case series of infants with complete UCLP who underwent KKU PNAM therapy. Patients with complete 3D stereophotogrammetric records at initial (T0) and pre-cheiloplasty (T1) visits were included.SettingKhon Kaen University Cleft Lip and Palate CenterPatients/ParticipantsSixteen infants with complete UCLPInterventionsKKU PNAMMain Outcome MeasuresAnthropometric measurements of nasolabial tissue of infants with complete UCLP were compared between pre- (T0) and post-PNAM treatment (T1) and against age-matched noncleft controls at both time points.ResultsFrom T0 to T1, cleft-sided nostril height and columellar length, height, and angle increased significantly (0.85 mm, 0.83 mm, 1.54 mm, and 17.38 degrees, respectively). Conversely, cleft-sided nostril width, deviated alar base and columella, and vermilion gap significantly decreased (1.57, 1.04, 0.68, and 4.19 mm, respectively). The difference of nostril width and height between cleft and noncleft side was decreased. At T0, alar base, subnasal, and nostril width, alongside the nostril and columellar height, differed from those of control infants. At T1, the columellar height in the treatment cohort was comparable to that of the control. Other parameters remained significantly different; however, these differences decreased post treatment.ConclusionsKKU PNAM therapy improved nasolabial morphology and symmetry in patients with UCLP, suggesting its potential to facilitate successful future cheiloplasty.
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Affiliation(s)
- Vanitchaya Udomvanit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Aggasit Manosudprasit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Rajda Chaichit
- Faculty of Dentistry, Division of Dental Public Health, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Amornrut Manosudprasit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
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Oday R, Abid M. Accuracy and Retention of Molding Plates Used for Infants with Cleft Lip and Palate Fabricated from Different Materials: A Cross-Sectional Clinical Study. Cleft Palate Craniofac J 2025; 62:371-379. [PMID: 37801511 DOI: 10.1177/10556656231202592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
ObjectivesThe study aimed to comparatively assess the accuracy and retention of molding plates made of polyethylene terephthalate modified with glycol (PET-G) and polymethyl methacrylate (PMMA) materials, while also investigating the effect of adhesive addition on retention.DesignA cross-sectional clinical study.Patients/settingThe study included 30 infants diagnosed with non-syndromic cleft lip and palate (16 unilateral, 14 bilateral). Two molding plates were fabricated for each infant, and their accuracy and retention were evaluated. The data were analyzed using independent t-tests, Mann-Whitney U tests, and Wilcoxon rank tests.Main outcome measuresAccuracy: The accuracy of the molding plates was assessed by measuring the virtual gap between the inner surface of the plates and their working cast using Exocad software. The accuracy was evaluated in different regions (anterior, middle, and posterior) and compared between PET-G and PMMA materials. Retention: The retention of the molding plates was measured using a digital force gauge, which recorded the force required to dislodge the plates from the infant's mouth. The retention was compared between PET-G and PMMA materials, as well as the effect of adhesive addition on retention. Overall adaptation; PET-G plates showed a significantly smaller gap (mean= 0.264 ±0.106) compared to PMMA (mean= 0.362 ±0.130). Region-specific adaptation: PET-G plates demonstrated better accuracy in all regions (means of anterior =0.246, middle =0.262, posterior =0.282 µm). Significant differences in accuracy were observed in the middle and posterior regions compared to PMMA. Retention assessment revealed that the PET-G groups (with or without adhesive) exhibited significantly higher retention compared to the PMMA groups (P<0.01).ConclusionPET-G plates demonstrated superior accuracy and retention compared to PMMA, with a significant difference observed in both accuracy and retention. Furthermore, the addition of denture adhesive had a positive effect on retention for both materials.
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Affiliation(s)
- Raghad Oday
- Department of Orthodontic, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Mushriq Abid
- Department of Orthodontic, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Alkebsi K, Abdo Y, Abotaleb B, Sakran KA, Shi B, Li C. Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique. J Plast Reconstr Aesthet Surg 2025; 102:480-488. [PMID: 39788846 DOI: 10.1016/j.bjps.2023.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/02/2023] [Accepted: 10/15/2023] [Indexed: 01/12/2025]
Abstract
BACKGROUND Improving growth-related nasal stability is a critical goal of primary cleft lip repair. The purpose of this study was to evaluate the growth-related stability of the nose after unilateral complete cleft lip (UCCL) repair with standard rotation-advancement (RA) and modified rotation-advancement (MRA) techniques. MATERIAL AND METHOD In this retrospective study, 52 non-syndromic (UCCL) patients were treated with a MRA technique, where a C-flap and a superiorly based advanced flap were used to lengthen and support the columella and nasal sill, and 48 patients were treated with a standard RA technique. Photos were taken before surgery (T1), immediately after surgery (T2), 1 year after surgery (T3), and 5 years after surgery (T4). Cleft width ratio, maxillary discrepancy, ala collapse, ala base position, columellar angle and height, nostril height, and width were all measured. The t-test, repeated-measure analysis of variance (ANOVA), stepwise multiple regression, inter-class correlation coefficient, and ANOVA with Bonferroni corrections were conducted. RESULTS MRA improved columellar height significantly at T3 and T4. Growth-related columellar height stability at T2-T4 was significantly better in the MRA group (P = 0.08) than in the standard RA group (P = 0.007). Nasal width was a moderate predictor of post-operative outcome, and maxillary discrepancy and ala collapse were moderate predictors of growth-related nostril height changes. CONCLUSION Both groups demonstrated the same measurement stability at 1 and 5 years, except for the columellar height in the standard RA group, which deteriorated and then improved over time due to unknown reasons. Furthermore, the MRA group had better columellar height symmetry than the standard RA group at 1 and 5 years after surgery.
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Affiliation(s)
- Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Yaser Abdo
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen; School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, China
| | - Bassam Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Chenghao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China.
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Gomaa Zeid MA, Abdel Gawad EMA, Ghanem MAM, AbdelRahman NI, Reda Mabrouk AAEW. Nasoalveolar Molding in Lately Presented Moderate to Severe Unilateral Cleft Lip and Palate Infants: Does it Add? J Craniofac Surg 2024:00001665-990000000-02030. [PMID: 39382554 DOI: 10.1097/scs.0000000000010729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/06/2024] [Indexed: 10/10/2024] Open
Abstract
Alignment of the alveolar segments with early nasal cartilage tackling is the foundation upon which excellent surgical results are dependent. The purpose is to evaluate the short-term effect of triple combination of passive alveolar molding with early nasal molding augmented by controlled corrective power of lip tapping in lately presented moderate to severe unilateral complete cleft lip and palate infants. A prospective case series study was conducted in Plastic and Maxillofacial Surgery Department, Ain Shams University in collaboration with Orthodontics Department, from January 2021 till June 2023, 15 infants elder than 2 months till 6 months were enrolled in the study. Eight nasal anthropometric measurements ratios through 2-dimension assessment and 4 maxillary arch measurements ratios through 3-dimension assessment were recorded. Extraoral results revealed clinically and statistically decrease of nasal width, alar base width, alar base height ratios, and columellar angle, while increase of nasal height, nasal dome height, columellar length, and alar projection length ratios. Intraoral results revealed clinically and statistically decrease in cleft width with maintained posterior arch width and intercanine width. In conclusion, this triple combination helped in presurgical lessening the alveolar and nasal deformity of such elder infants in a shorter time in comparison with other conventional methods with lesser number of appointments decreasing burden of care to their families improving their compliance.
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Affiliation(s)
| | | | | | - Noha I AbdelRahman
- Department of Orthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Alqutaibi AY, Hamadallah HH, Alassaf MS, Othman AA, Qazali AA, Alghauli MA. Artificial intelligence-driven automation of nasoalveolar molding device planning: A systematic review. J Prosthet Dent 2024:S0022-3913(24)00637-1. [PMID: 39368883 DOI: 10.1016/j.prosdent.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 10/07/2024]
Abstract
STATEMENT OF PROBLEM Despite the increasing number of publications on applying artificial intelligence (AI) in the dental field, clarity regarding the performance of different approaches for nasoalveolar molding (NAM) planning and designing is lacking. Additionally, the overall robustness of the evidence in this field remains uncertain. PURPOSE The purpose of this systematic review was to evaluate the role of AI in automating the prediction of anatomic landmarks and the design of NAM appliances. MATERIAL AND METHODS A comprehensive literature search was conducted in major databases up to April 2024 without language restrictions. Studies applying AI algorithms for NAM landmark detection or appliance design were included. Data on study characteristics, AI methods, outcomes, and limitations were extracted. RESULTS Six studies met the eligibility criteria. AI algorithms demonstrated high accuracy in automatically detecting landmarks and designing NAM appliances. Approaches ranged from fully automated to semi-automated workflows. Most studies reported significant time savings compared with manual methods. CONCLUSIONS AI applications in NAM demonstrate substantial potential in improving workflow design, as demonstrated by the high accuracy reported in various studies. The incorporation of AI in NAM planning leads to a significant reduction in treatment appointment times when compared with conventional manual methods, thereby potentially decreasing the overall duration of treatment. Nevertheless, additional research is required to foster better collaboration between dental professionals and AI experts, ultimately facilitating more efficient clinical integration.
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Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Associate Professor, Substitutive Dental Sciences Department (Prosthodontics), College of Dentistry, Taibah University, Al Madinah, Saudi Arabia; and Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen.
| | - Hatem Hazzaa Hamadallah
- Postgraduate student, Department of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Taibah University, Al Madinah, Saudi Arabia
| | - Muath Saad Alassaf
- Postgraduate student, Department of Oral and Maxillofacial Surgery, King Fahad Hospital, Al Madinah, Saudi Arabia
| | - Ahmad A Othman
- Assistant Professor, Department of Oral and Maxillofacial diagnostic sciences, College of Dentistry, Taibah University, Al Madinah, Saudi Arabia
| | - Ahmad A Qazali
- Assistant Professor, Substitutive Dental Sciences Department (Prosthodontics), College of Dentistry, Taibah University, Al Madinah, Saudi Arabia
| | - Mohammed Ahmed Alghauli
- Assistant Professor, Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen
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Diao JS, He L, Yu XY, Liu XY, Guo Y, Lin YY, Chen J, Rahman MA, Ullah I, Shu MG. Secondary rhinoplasty for unilateral cleft lip nasal deformity using the complex of autologous costal cartilage and fascia grafts. J Plast Reconstr Aesthet Surg 2024; 99:238-246. [PMID: 39388766 DOI: 10.1016/j.bjps.2024.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/13/2024] [Accepted: 09/23/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Secondary unilateral cleft lip nasal deformity is a prevalent condition in the world, and surgical repair remains a formidable challenge. The objective of the study is to investigate functionally and aesthetically outcomes of a new technique using a complex of autologous costal cartilage and fascia grafts to repair the secondary unilateral cleft lip nasal deformity. METHODS First, the autologous costal cartilage and fascia were harvested from a total of 34 patients with secondary unilateral cleft lip nasal deformity, who were undergoing treatments at the First Affiliated Hospital of Xi'an Jiaotong University from April 2020 to June 2023. Then, the cartilage was sub-divided into 6 pieces and placed on the depressed alar base, nasal columella, lower lateral cartilage, and nasal tip. At the same time, the fascia was trimmed to cover the nasal tip cap graft and augment the dorsum of the nose. Patient outcomes were assessed through subjective evaluation and objective anthropometric measurements. In addition, associated complications were also examined. RESULTS All were primary healing incisions, and no patients were encountered with any clinical complications. We found that the overall mean score of the Independent Rhinoplasty Outcome Score (IROS) was very good during the subjective assessment. Also, the objective measurements indicated an excellent nasal symmetry. Furthermore, both functionally and aesthetically satisfactory outcomes were obtained in all the patients during long-time follow-up. CONCLUSIONS Secondary rhinoplasty using the complex of autologous costal cartilage and fascia grafts is a safe and effective approach for unilateral cleft lip nasal deformity repair.
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Affiliation(s)
- Jian-Sheng Diao
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Lin He
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xue-Yuan Yu
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xiang-Yu Liu
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yuan Guo
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yu-Yao Lin
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jia Chen
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Md Atiqur Rahman
- Department of Plastic Surgery, East West Medical College and Hospital, Turag, Dhaka, Bangladesh
| | - Irfan Ullah
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Mao-Guo Shu
- Department of Plastic, Aesthetic and Maxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China.
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Sennimalai K, Selvaraj M, Sameemullah KH, Gothankar GS, Siddiqui HP, Arora G, Mohaideen K. Research Trends in Presurgical Infant Orthopaedic Treatment in Patients with Cleft Lip and Palate: A Bibliometric Analysis of 100 Most-Cited Articles. Cleft Palate Craniofac J 2024:10556656241285812. [PMID: 39314073 DOI: 10.1177/10556656241285812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVE To assess research trends and publication patterns of literature related to presurgical infant orthopaedics (PSIO) through a bibliometric analysis of the top 100 most-cited articles. MATERIAL AND METHODS The top 100 most-cited articles were identified in the Web of Science (WoS) database using search terms related to PSIO on April 23, 2024, without any restrictions to study design, publication date and language. Standard information about each study was extracted. Citations from WoS, Scopus and PubMed databases were compared. The level of evidence for each article included was assessed. Association between different variables was calculated using Spearman's correlation coefficient with statistical significance set at p < 0.05. Visual analysis of the author's keyword co-occurrence, co-authorship analysis of authors, and citation analysis of journals and authors were performed using VOSviewer. RESULTS Top cited articles were published from 1994 to 2020, with total individual database citations being WoS (n = 5378), Scopus (n = 6184) and PubMed (n = 10 450). Eleven articles were considered classic articles. Cleft Palate and Craniofacial Journal (Impact Factor = 1.1) had a maximum number of articles and citations. Two hundred eighty-five individuals contributed to top-cited articles, with 62 corresponding authors from 19 countries. A maximum number of authors were affiliated with universities in the United States. The most common keyword used was "nasoalveolar molding (n = 24)", "cleft palate (n = 16)", and "infant orthopedics (n = 16)". The study design of the majority of articles was retrospective and follow-up studies (level 3; n = 53). A weak negative correlation was observed between citation metrics and both the publication year (P < 0.01) and the level of evidence (P < 0.01). CONCLUSION This analysis recognises the contributions of experts and offers valuable insights into trends that have shaped the development and evidence related to PSIO research. Future research should focus on integrating advanced technologies, conducting longitudinal studies, fostering collaboration, and emphasizing patient-centred outcomes.
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Affiliation(s)
- Karthik Sennimalai
- Department of Orthodontics, All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - Madhanraj Selvaraj
- Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Greeshma Shantharam Gothankar
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Garima Arora
- Department of Orthodontics, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Kaja Mohaideen
- Department of Research Analytics, Saveetha Dental College and Hospital, Chennai, India
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Kumar V, Firdaws H, Fernandes S. Nasoalveolar Molding Therapy in a Newborn With Cleft Lip and Palate: A Case Report. Cureus 2024; 16:e69425. [PMID: 39411611 PMCID: PMC11473672 DOI: 10.7759/cureus.69425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/19/2024] Open
Abstract
Cleft lip and palate are common congenital deformities that significantly impact facial anatomy and function, often requiring surgical intervention to correct. Presurgical nasoalveolar molding (NAM) therapy has emerged as an effective nonsurgical approach to improve surgical outcomes by reducing the severity of clefts and molding the alveolar, lip, and nasal segments into more favorable positions. This case report describes the use of NAM therapy in a 15-day-old patient with unilateral cleft lip, palate, and nasal involvement to improve outcomes before cheiloplasty. The patient presented with significant feeding difficulties due to a large palatal cleft. After obtaining parental consent, we conducted a series of procedures to construct and insert an acrylic NAM plate with a retention button and nasal stent, performing weekly adjustments to reshape the alveolar segments and nasal cartilage. Weekly remodeling included selective modifications to the NAM plate, the addition of soft liners, and the use of nasal stents to lift the collapsed nasal cartilages and restore nasal symmetry. Post-treatment results showed a substantial reduction in the cleft lip gap from 17 mm to 6 mm, alveolus gap from 14 mm to 4 mm, left nasal width from 17 mm to 11 mm, and increased left alar height from 4 mm to 7 mm. The successful application of NAM therapy demonstrated its effectiveness in reducing cleft gaps, improving nasal anatomy, and preparing the patient for future surgical interventions with minimal scar formation. This case reinforces the benefits of NAM in reducing cleft deformities, improving feeding function, and avoiding more invasive surgical procedures.
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Affiliation(s)
- Vinod Kumar
- Pediatric Dentistry, Navodaya Dental College and Hospital, Raichur, IND
| | - Hibah Firdaws
- Pediatric Dentistry, Navodaya Dental College and Hospital, Raichur, IND
| | - Shobha Fernandes
- Pediatric Dentistry, Narsinhbhai Patel Dental College and Hospital, Visnagar, IND
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Saito T, Hattori Y, Tu JCY, Lo LJ. Effective Correction of Columellar Base Deviation in Primary Unilateral Cleft Lip Repair: A Muscle-Driven Method. Plast Reconstr Surg 2024; 154:573e-576e. [PMID: 37337334 DOI: 10.1097/prs.0000000000010870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
SUMMARY Columellar base deviation is a common and challenging deformity in patients with unilateral cleft lip. Debate continues on its surgical correction without sufficient studies to establish effective management. This article presents the authors' experience in correcting the columellar base deviation with the muscle-driven method in primary lip repair. The key is to perform extensive muscle dissection and reconstruction. In the medial lip segment, muscle dissection is performed subcutaneously up to the contralateral nostril floor for effective lengthening and rotation. In the lateral lip segment, muscle dissection is executed in both submucosal and subcutaneous planes, and muscle component is extensively separated from the lip skin and buccal mucosa. The lateral muscle flap is advanced and reattached to the contralateral nostril floor and columellar base using a subcutaneous sustaining suture. Cinching suture between columellar base and alar base is performed. These 2 sutures help centralize and overcorrect the columellar base. Bilateral muscle components are reoriented and approximated in a Z-plasty format for lengthening of the lip. The patients were followed up for at least 3 years. Quantitative measurements of deviation in columellar base angulation were taken and revealed 55.8 ± 2.6 degrees (before nasoalveolar molding), 29.6 ± 1.7 degrees (after nasoalveolar molding), and 2.8 ± 0.4 degrees (postoperative follow-up), respectively. The muscle-driven method represents a safe and effective technique to correct columellar base deviation in patients with unilateral cleft lip.
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Affiliation(s)
- Takafumi Saito
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Yoshitsugu Hattori
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Junior Chun-Yu Tu
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Lun-Jou Lo
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
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Ho Nguyen CT, La TN, Nguyen DV. Three-Dimensional Evaluation of Nasolabial Morphology After Applying Presurgical Nasoalveolar Molding in Primary Unilateral Cheiloplasty Using the Modified Millard Technique. Cleft Palate Craniofac J 2024; 61:1532-1537. [PMID: 37198916 DOI: 10.1177/10556656231175554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. DESIGN Descriptive clinical study with one group, prospective. SETTING Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. PATIENTS 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. INTERVENTIONS Interventions include PNAM and cheiloplasty by modified Millard technique. MAIN OUTCOME MEASURES Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. RESULTS After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). CONCLUSION Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side.
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Affiliation(s)
- Chon T Ho Nguyen
- Department of Maxillofacial Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuyen N La
- Department of Odonto-Stomatology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Dau V Nguyen
- Department of Odonto-Stomatology, Children's Hospital 1, Ho Chi Minh City, Vietnam
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Soni N, Niranjane P, Purohit A. Role of Growth Factors in Nasal Cartilage Development and Molding: A Comprehensive Review. Cureus 2024; 16:e67202. [PMID: 39295663 PMCID: PMC11409944 DOI: 10.7759/cureus.67202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
This review aims to investigate the properties of growth factors concerning the morphogenesis and development of nasal cartilage, which is fundamentally important for facial form and appearance. Since cartilage lacks a blood supply, it is more difficult to regenerate, as cartilage tissue obtains sustenance by diffusion. Cytokines are signalling molecules that control chondrocyte metabolism and extracellular matrix formation, which is required for cartilage development, homeostasis, and healing. Some craniofacial illnesses alter the composition of the cartilage and the structural organization of growth factors, allowing for moulding. TGF-β (transforming growth factor-β) encourages chondrocyte differentiation, whereas IGF-1 (insulin-like growth factor-1) stimulates cartilage-forming collagen synthesis and chondrocyte multiplication. We used the scoping review approach to present current research on the role of growth factors in the creation and architecture of nasal cartilage. We generally observed this structure before conducting specific experiments to determine the impact of growth agents on the development of chondrocytes and cartilage. Prominent findings increase our understanding of how growth factors influence the extracellular matrix, cell activities and features, and cartilage growth rate; all are critical for cartilage tissue development and repair. Research into growth factors and their physiological interactions with cartilage may help improve treatment's functional and aesthetic outcomes and our understanding of the origins and consequences of nasal congenital anomalies. This study emphasizes the importance of expanding knowledge and experience, as well as the use of growth factors in clinical practice, to stimulate cartilage development.
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Affiliation(s)
- Nikita Soni
- Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka Niranjane
- Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akanksha Purohit
- Neglected Tropical Diseases, Global Health Strategies, Delhi, IND
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Taori KP, Niranjane P, Kamble R. Presurgical Nasoalveolar Molding and Columella Lengthening for Early Unilateral Cleft Lip and Palate Rehabilitation: A Comprehensive Clinical Case Report. Int J Clin Pediatr Dent 2024; 17:955-961. [PMID: 39372347 PMCID: PMC11451874 DOI: 10.5005/jp-journals-10005-2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024] Open
Abstract
Aim and background In presurgical infant orthopedics, nasoalveolar molding (NAM) therapy has gained more popularity worldwide in treating patients with cleft lip and palate because of its soft tissue nasal corrections in addition to the alignment and close approximation of the cleft alveolar segments, which gives better postsurgical stability and esthetics with minimal tissue tension and scar formation to the patients.The clinical case report aims to show the better post-NAM results, which had helped to gain better postsurgical results in terms of stability and aesthetics in hard and soft tissues. Case description This clinical report presents the case of a 9-day-old female patient reported in the Department of Orthodontics and Dentofacial Orthopedics at Sharad Pawar Dental College and Hospital with nonsyndromic complete left-sided unilateral cleft lip and palate with a defect size of 13 mm, which was treated with a presurgical nasoalveolar molding (PNAM) appliance. NAM therapy takes advantage of circulating maternal estrogen, bringing pliability to the cartilage cells for presurgical cartilage molding. This has resulted in the closure of the alveolar defect from 13 mm to <2 mm in the present case, with nasal symmetry restoration due to nasal stent within 12 weeks of active treatment; hence, the postsurgical esthetics are maintained. Conclusion NAM therapy remained beneficial and had significant aesthetic results in reducing the cleft defect size. Because of this, it gained a big surgical advantage in reducing tissue tension, primary stability, and scar formation. Clinical significance By reducing the cleft defect size of the dysplastic maxillae, which brings the lip segments and alveolar segments closer to each other, it thus reduces the defect size for primary lip and palate repair. This serves as the biggest advantage for maxillofacial and plastic surgeons to maintain the posttreatment results with redefined aesthetics and symmetry. How to cite this article Taori KP, Niranjane P, Kamble R. Presurgical Nasoalveolar Molding and Columella Lengthening for Early Unilateral Cleft Lip and Palate Rehabilitation: A Comprehensive Clinical Case Report. Int J Clin Pediatr Dent 2024;17(8):955-961.
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Affiliation(s)
- Kushal P Taori
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Priyanka Niranjane
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
| | - Ranjit Kamble
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India
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Yadav L, Mattu N, Mehra P, Jain P. A Comprehensive Approach to Unilateral Cleft Lip and Palate Management through Presurgical Nasoalveolar Molding and Surgical Repair in a Neonate. Contemp Clin Dent 2024; 15:213-216. [PMID: 39512286 PMCID: PMC11540197 DOI: 10.4103/ccd.ccd_12_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 07/23/2024] [Accepted: 08/05/2024] [Indexed: 11/15/2024] Open
Abstract
This case report details the successful application of nasoalveolar molding (NAM) in a 4-day-old neonate with a complete unilateral cleft lip and palate, showcasing a comprehensive treatment approach involving presurgical NAM and subsequent surgical repair. The NAM technique, pioneered by Barry H. Grayson, utilizes a specialized appliance to shape the alveolar ridge and nasal cartilage concurrently. The case demonstrates favorable outcomes, with the alveolar segments brought closer to normalcy after approximately 4 months of NAM. The patient underwent further surgical repair, as per the protocol emphasizing the interdisciplinary approach in cleft management.
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Affiliation(s)
- Lucky Yadav
- Department of Dental and Oral Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Navraj Mattu
- Department of Dental and Oral Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Pravesh Mehra
- Department of Dental and Oral Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Pooja Jain
- Department of Dental and Oral Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Nirunrungrueng P, Virarat P, Techalertpaisarn P, Ungvijanpunya N. Nasolabial morphological changes in patients with unilateral cleft lip and palate using a Korat-modified nasoalveolar moulding appliance with primary correction. Orthod Craniofac Res 2024; 27 Suppl 1:80-89. [PMID: 38305564 DOI: 10.1111/ocr.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The objective of this study is to measure the morphological changes of the nose and lip in patients with unilateral cleft lip and palate before and after cheiloplasty with primary rhinoplasty (primary correction) in conjunction with Korat-NAM usage. DESIGN Longitudinal cohort study. SETTING Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. SUBJECTS Twenty-six patients with unilateral cleft lip and palate. INTERVENTIONS Control group: only active obturator before primary correction. Experimental group: an active obturator and Korat-NAM I before primary correction. A customized endotracheal tube was retained in the nostril for 3 weeks before switching to Korat-NAM II for 1 year. MAIN OUTCOME MEASURES Six measurements comprising nostril rim length, nostril height, nostril sill width, columella angle, vertical lip height, and horizontal lip length were measured from the patients' photographs. All measurements, except the columella angle, were reported as the cleft side/non-cleft side value ratio. Measurements were taken at the initial appointment, immediately before, 3 weeks after, and 1 year after primary correction. RESULTS Nostril rim length ratio, nostril height ratio, nostril sill width ratio, columella angle on the cleft side, and vertical lip height ratio were improved using Korat-NAM before and 3 weeks after primary correction. Nostril rim length and height ratios were significantly better than the control group. CONCLUSIONS Korat-NAM improved nose and lip morphology before primary correction. An overcorrection improved the nose and lip morphology on the cleft side. The nostril rim length and vertical lip height on the cleft side also improved with Korat-NAM II 1 year after primary correction.
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Affiliation(s)
| | - Pongjai Virarat
- Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | - Nicha Ungvijanpunya
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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17
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Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, Santiago PE. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J 2024; 61:654-677. [PMID: 36330703 DOI: 10.1177/10556656221136325] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. MAIN OUTCOME MEASURES Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. RESULTS A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. CONCLUSIONS Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
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Affiliation(s)
| | | | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Andrew Hollins
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Ronnie Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Alexander C Allori
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Pedro E Santiago
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
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Al-Lami HA, Al-Rudainy D, Mohammed-Salih HS, Salman SM. Presurgical management trends and nasoalveolar molding usage for infants with cleft lip and palate in the capital of a developing country. J Orthod Sci 2024; 13:4. [PMID: 38516115 PMCID: PMC10953715 DOI: 10.4103/jos.jos_165_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUNDS Nasoalveolar molding (NAM) application is among presurgical management (PSM) techniques used for infants with cleft lip and palate (CLP). It helps to approximate the palatal cleft and to reshape the nasoalveolar complex prior to primary lip repair. This study aimed to explore types of PSM and the dental speciality provision for infants with CLP in Baghdad. The status of NAM usage and surgeons' perceptions toward NAM usage were assessed. MATERIALS AND METHODS This is a cross-sectional paper-based questionnaire study that collected responses of surgeons perform primary lip and nose repair regarding PSM. The questionnaire was distributed amongst public and private hospitals in Baghdad. Twenty surgeons were enrolled (only those surgeons who perform primary repair for infants with CLP); two females and eighteen males. RESULTS The majority of participants' responses suggested that the majority of infants with CLP were provided with baby feeding plates and lip straps. Six surgeons reported that a percentage of their patients who have been provided with NAM. PSM in Baghdad was mostly supplied by orthodontists and plastic surgeons, and the next most likely providers were prosthodontists. 82.35% of the surgeons found that primary surgical repair procedures were easier with NAM than for the other infants. The rest have not perceived any differences. CONCLUSIONS Orthodontists, surgeons and prosthodontists were involved in providing PSM. Baby feeding plates and lip straps were the most common PSM in Baghdad, although NAM is not uncommon. Most surgeons believe that using NAM made surgical procedures easier and permitted the prediction of surgical outcomes.
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Affiliation(s)
- Hadeel Adel Al-Lami
- Orthodontics Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Dhelal Al-Rudainy
- Orthodontics Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Shivanna MP, Hiriyanna NM, Kumar H, Athreya SV. Dynamic Molding of Cleft Nasal Cartilage in Unilateral Complete Cleft Lip and Palate Using Simple Segmented NAM. J Maxillofac Oral Surg 2023; 22:946-953. [PMID: 38105845 PMCID: PMC10719226 DOI: 10.1007/s12663-023-01980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/19/2023] [Indexed: 12/19/2023] Open
Abstract
Objective Nasal morphology remodeling by nasoalveolar molding (NAM) before primary lip repair gives better post-surgery outcomes. However, traditional NAM has high technical sensitivity, a steep learning curve, frequent need for modifications, and interrupts lifting forces on the nasal cartilage during oral movements, thereby reducing overall efficacy of device. To eliminate interaction and interdependency of the nasal bulb with alveolar molding plate, we propose segmenting NAM (SNAM) into nasolabial complex molding (NCM) and alveolar complex molding (ACM). NCM addresses ala-septum, lip-premaxilla via lambda-nasal hook and lip taping. ACM addresses palate-alveolus via Yen-modified feeding plate. When the hook is suspended by elastic traction, nasal complex undergoes a natural rotation, where cleft-side ala lifts and septum medializes. Lip taping and feeding plate augment positive molding of cleft segments and maintain transverse relation. The current study outlines SNAM treatment strategy and assesses the effect on nasal deformity. Design and setting Retrospective observational cohort study set in a comprehensive cleft care centre. Patients Twenty patients with unilateral complete cleft lip and palate who underwent SNAM were selected. Main outcome measures Retrospectively, standardized basilar views, pre-, and post-SNAM therapy were evaluated for nostril height, and nostril width, as a ratio of cleft to non-cleft side along with columellar deviation angle. Results SNAM resulted in significantly improved nostril symmetry with no complications observed. Nostril height ratio increased from 0.35 ± 0.10 to 0.78 ± 0.17. Nostril width ratio decreased from 3.14 ± 0.66 to 2.18 ± 0.42. Columellar deviation angle increased from 26.5 ± 6.30 to 58.5 ± 9.88 degrees. Conclusions Dynamic correction of the nasal deformity in UCLP is possible through SNAM therapy.
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Affiliation(s)
- Manu Prasad Shivanna
- ABMSS Comprehensive Cleft Care Centre, Mysore, 570015 India
- Oral and Maxillofacial Surgery, Farooqia Dental College, Rajiv Gandhi University of Health Sciences, Mysore, 570015 India
| | | | - Harish Kumar
- ABMSS Comprehensive Cleft Care Centre, Hyderabad, 500007 India
| | - Surabhi V. Athreya
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurugram, 122505 India
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20
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Taori KP, Niranjane PP, Daigavane P. Nasal Cartilage Molding in a Case of Unilateral Cleft Lip and Alveolus (Type D): A Case Report. Cureus 2023; 15:e50998. [PMID: 38259383 PMCID: PMC10802890 DOI: 10.7759/cureus.50998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Nasal cartilage is asymmetric in individuals with cleft lips and has a depressed nasal dome and medial and lateral crus of the nose on the affected cleft side which can be corrected before cheiloplasty by taking advantage of circulating maternal estrogen. This case report presents pre-surgical nasal cartilage molding in a patient with unilateral cleft lip and alveolus using the Sawangi Pre-surgical Nasal Cartilage Molder appliance. The appliance is made from 0.8 mm stainless-steel round wire and has three components, namely, a rectangular frame, a force-generating component, and a swan-shaped wire framework with a soft liner for nasal asymmetry correction.
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Affiliation(s)
- Kushal P Taori
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka P Niranjane
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Daigavane
- Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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21
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Singhal R, Negi S, Bhagol A, Namdev R. Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate. J Maxillofac Oral Surg 2023; 22:954-960. [PMID: 38105829 PMCID: PMC10719207 DOI: 10.1007/s12663-023-01993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
Background Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child. Aim To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect. Material and Methods The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree. Discussion For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc. Conclusion The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.
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Affiliation(s)
| | | | - Amrish Bhagol
- Department of Oral and Maxillofacial Surgery, PGIDS, Rohtak, India
| | - Ritu Namdev
- Department of Pedodontics, PGIDS, Rohtak, India
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22
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Chang FCS, Huang JJ, Wallace CG, Hsiao YC, Chen ZC, Liao YF, Chen PKT. Comparison of Facial Growth between Two Nasoalveolar Molding Techniques in Patients with Unilateral Complete Cleft Lip. Plast Reconstr Surg 2023; 152:1078-1083. [PMID: 36940137 DOI: 10.1097/prs.0000000000010448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nasoalveolar molding (NAM) has become standard treatment in the authors' craniofacial center. There are two types of presurgical NAM: the Grayson and Figueroa techniques. The Grayson method involves active alveolar molding, and the Figueroa method involves passive alveolar molding. The authors previously found no differences in number of clinic visits, costs, or 6-month postoperative outcome between the two techniques. The authors extended the previous study to evaluate facial growth between these two groups. METHODS In this randomized single-blind study, conducted between May of 2010 and March of 2013, the authors recruited 30 patients with unilateral complete cleft lip and palate and randomized them for Grayson or Figueroa presurgical NAM. Standard lateral cephalometric measurements at 5 years were used to determine facial growth. RESULTS Twenty-nine patients completed 5 years of follow-up. There were no statistically significant differences in facial cephalometric measurements between the two groups. CONCLUSION Presurgical NAM using either a passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Frank Chun-Shin Chang
- From the Craniofacial Research Center, Department of Medical Research, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Jung-Ju Huang
- From the Craniofacial Research Center, Department of Medical Research, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Christopher Glenn Wallace
- From the Craniofacial Research Center, Department of Medical Research, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University
| | - Yen-Chang Hsiao
- From the Craniofacial Research Center, Department of Medical Research, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Zung-Chung Chen
- From the Craniofacial Research Center, Department of Medical Research, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
| | - Yu-Fang Liao
- Craniofacial Research Center and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University
| | - Philip Kuo-Ting Chen
- Department of Plastic and Reconstructive Surgery, Taipei Medical University Hospital
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23
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Oh TS, Kim YC. A comprehensive review of surgical techniques in unilateral cleft lip repair. Arch Craniofac Surg 2023; 24:91-104. [PMID: 37415466 PMCID: PMC10365900 DOI: 10.7181/acfs.2023.00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures.
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Affiliation(s)
- Tae-Suk Oh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Alkebsi K, Sakran KA, Abdo Y, Shi B, Li C. Stability of nasal symmetry following primary cleft lip and nasal repair: five years of follow-up. Int J Oral Maxillofac Surg 2023; 52:451-459. [PMID: 35973881 DOI: 10.1016/j.ijom.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Despite advances in cleft lip treatment, various levels of residual deformity remain after primary repair of cleft lip and palate. The aim of the current study was to compare the stability of short- and long-term postoperative nasal symmetry. This retrospective study included 100 consecutive non-syndromic patients with unilateral complete cleft lip who underwent primary cleft lip repair with follow-up of 5 years. Measurements taken from basal and frontal standard photograph views, obtained preoperatively (T1) and immediately (T2), 1 year (T3), and 5 years postoperative (T4), were analysed. Paired and independent t-tests were applied to assess the significance of differences and relationships, while the inter-class correlation coefficient was used to assess reliability; P < 0.05 was considered significant. The male to female ratio was 1:1; mean age at the time of surgery was 0.43 ± 0.25 years. All patients showed significant improvements following unilateral complete cleft lip repair. All variables measured at T3 revealed a significant relapse when compared to T2, except alar base position, which showed a constant mean across all postoperative follow-ups. Late relapse (T3-T4) was not significant for alar collapse, alar base position, or columellar angle (all P > 0.05). On the other hand, columellar height (P = 0.003), and nostril height (P = 0.038) and width (P = 0.007) showed significant improvements during the late relapse period. In conclusion, the majority of the relapse and changes following the nasal cleft repair occurred within the first postoperative year. However, nasal asymmetries tended to remain stable or reduced during the first 5 postoperative years.
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Affiliation(s)
- K Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - K A Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Y Abdo
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen; School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - B Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - C Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Efficacy of Post-Surgical Nostril Retainer (PSNR) in patients with UCLP Treated with Pre-Surgical NasoAlveolar Molding (NAM) and Primary Cheiloplasty-Rhinoplasty. Plast Reconstr Surg 2022; 150:623-629. [PMID: 35787611 DOI: 10.1097/prs.0000000000009426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this investigation is to determine if the nasal form of patients with unilateral cleft lip and palate (UCLP) treated with pre-surgical nasoalveolar molding (NAM) therapy, primary lip-nose surgery, and post-surgical Nostril Retainer (PSNR) is different from patients treated with pre-surgical NAM and primary lip and nose surgery alone. DESIGN A cross-sectional, retrospective review of 50 consecutive non-syndromic patients with UCLP: 24 treated with NAM and primary lip-nose surgery followed by PSNR (Group I) compared to 26 patients treated with NAM and primary lip-nose surgery without PSNR (Group II). Polyvinyl siloxane nasal impressions were performed at the average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparison of cleft versus non-cleft side nasal measurements were performed within Group I and Group II, as well as comparison of the difference between the two groups. RESULTS Cleft side nasal dimension was statistically significantly better in Group I than Group II across all measures except nasal projection (P<0.05). Group I showed less difference between the cleft and non-cleft side in all six measurements than Group II (p<0.05). CONCLUSION There is a significant difference in the nasal shape of patients who underwent PSNR compared to those that did not. The patients who used PSNR showed better nasal shape at the average age of 12 months than the control group.
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Fujimoto M, Mano M, Sasaki A, Hasegawa H, Suzuki M, Nojiri N, Minami Y, Tokioka K, Suda N. Three-dimensional Analysis of Factors Related to the Effective Alveolar Molding in Presurgical Infant Orthopedics: Findings From a Pilot Study. Cleft Palate Craniofac J 2022:10556656221083804. [PMID: 35234083 DOI: 10.1177/10556656221083804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Presurgical infant orthopedics (PIO) reduces the severity of the original cleft and burden on patients and their parents, provides better esthetics and function, and enables surgeons to achieve better surgical repair. To reduce the alveolar cleft width and to predict treatment difficulty using PIO, various measures were examined in pretreatment cast models. DESIGN Retrospective case-control pilot study. PATIENTS The patients were 22 infants with non-syndromic unilateral cleft lip and palate (UCLP), and cast models of these infants were used. METHODS After PIO using passive plates, infants with UCLP were divided into two groups: contact group (12 cases with close proximity of the greater and lesser segments) and non-contact group (10 cases without proximity of segments). The two groups were compared, and variables related to the proximity between alveolar clefts were examined. RESULTS There was no significant difference in age at PIO initiation between the two groups. However, the treatment duration was significantly longer in the non-contact group than in the contact group. Among the 13 variables, the initial lateral deviation of the nasal septum was significantly larger in the contact group than in the non-contact group. A significant positive correlation was observed between the initial lateral deviation of the nasal septum and reduction of the alveolar cleft width by PIO. CONCLUSION Initial lateral deviation of the nasal septum is a predictive factor for the proximity between alveolar segments in infants with UCLP at the PIO.
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Affiliation(s)
- Mai Fujimoto
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Mikiko Mano
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Au Sasaki
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Hiroya Hasegawa
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Masaharu Suzuki
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Naoko Nojiri
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Yuri Minami
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
| | - Kazuyuki Tokioka
- Department of Plastic and Reconstructive Surgery, Saitama Medical University, Japan
| | - Naoto Suda
- Division of Orthodontics, Department of Human Development and Fostering, Meikai University School of Dentistry, Japan
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Zhang S, Yang C, Wu M, Yin J, Zeng N, Shi B, Huang H. Application of a Novel Nasal Clip for Nostril Retention After Primary Unilateral Cleft Rhinoplasty. Cleft Palate Craniofac J 2022:10556656221083812. [PMID: 35234533 DOI: 10.1177/10556656221083812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the outcomes of using a novel nasal clip designed for nostril retention after primary unilateral cleft rhinoplasty. DESIGN This is a retrospective study. SETTING Department of Cleft Lip and Palate in a stomatological hospital. PATIENTS A retrospective study was conducted on 57 patients who had a unilateral complete cleft lip without cleft palate and underwent primary surgical repair. INTERVENTIONS The patients were categorized into 3 groups: the group in which the conventional nasal retainer was used, that in which the nasal clip was used, and the control group in which no postoperative nasal retainer was used. The nasal retainer or our nasal clip was applied 7 days after primary surgical repair and kept in the nostrils of children from 6 to 12 months. MAIN OUTCOME MEASURES Noses underwent photogrammetry preoperatively, postoperatively, and at follow-up. The nose was also subjectively scored at the follow-up. RESULTS The nasal retainer and the nasal clip significantly minimized relapse as determined by nasal tip deviation. The nasal clip sustained nasal symmetry, as determined by the postoperative nostril width ratio, better than did the conventional retainer. After 6 to 12 months, the nasal clip achieved better columellar morphology and a more symmetric nasal base than did the conventional nasal retainer. Statistical differences in subjective scores between the control and nostril retention groups were noted. CONCLUSION The application of the novel nasal clip after primary unilateral cleft rhinoplasty preserves nasal morphology and reduces postoperative relapse without the need for adhesive tape.
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Affiliation(s)
- Shiming Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Min Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Jiayi Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, 12530Sichuan University, Chengdu, Sichuan, China
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Lu TC, Bhandari K, Yao CF, Chen PKT. The effect of botulinum toxin A in unilateral cleft lip scar: comparison of results with different sites of injection. Int J Oral Maxillofac Surg 2022; 51:900-905. [PMID: 35012827 DOI: 10.1016/j.ijom.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Botulinum toxin type A (BTA) injections into the subjacent orbicularis oris muscle have been shown to improve appearance and produce narrower cheiloplasty scars. This study was performed to determine the effect of BTA injected at different sites on the unilateral cleft lip scar and cleft side nostril width. A double-blind, randomized prospective trial was conducted involving 64 consecutive patients with unilateral cleft lip undergoing primary cheiloplasty between September 2016 and January 2019. The patients were randomized to receive BTA injections either into the subjacent orbicularis oris muscle (4 points group) or into the bilateral nasolabial fold region (6 points group) during cheiloplasty. The scars were assessed by photographic scar width measurements and Vancouver scar scale assessment tool. The cleft side nostril width was compared to the non-cleft side width. Fifty-six patients completed the trial, 24 in the 4 points group and 31 in the 6 points group. There was no significant difference in scar width or nostril width measurements between the groups at the end of follow-up. The Vancouver scar scale assessment was also similar between the groups. There was no significant difference in scar width or nostril width measurements after cleft lip repair between patients treated with botulinum toxin injections to the subjacent orbicularis oris muscle and patients treated with injections in the nasolabial region.
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Affiliation(s)
- T-C Lu
- Craniofacial center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - K Bhandari
- Craniofacial center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - C-F Yao
- Craniofacial center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - P K-T Chen
- Department of Plastic and Reconstructive Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2021; 148:775e-784e. [PMID: 34705782 DOI: 10.1097/prs.0000000000008463] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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30
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Aihara Y, Yanagawa T, Sasaki M, Sasaki K, Shibuya Y, Adachi K, Togashi S, Takaoka S, Tabuchi K, Bukawa H, Sekido M. Nasal molding prevents relapse of nasal deformity after primary rhinoplasty in patients with unilateral complete cleft lip: An outcomes-based comparative study of palatal plate alone versus nasoalveolar molding. Clin Exp Dent Res 2021; 8:197-208. [PMID: 34689427 PMCID: PMC8874052 DOI: 10.1002/cre2.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives In recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors. Materials and methods The patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left–right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc‐Grn∠midline and midline∠columellar axis). Results The area ratio, perimeter ratio, and Grc‐Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months. Conclusions The results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.
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Affiliation(s)
- Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoichiro Shibuya
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koji Adachi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Togashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuhiko Tabuchi
- Department of Molecular and Cellular Physiology, Institute of Medicine, Academic Assembly, Shinshu University, Nagano, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kalaskar R, Bhaje P, Sharma P, Balasubramanian S, Ninawe N, Ijalkar R. Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial. J Korean Assoc Oral Maxillofac Surg 2021; 47:257-268. [PMID: 34462383 PMCID: PMC8408650 DOI: 10.5125/jkaoms.2021.47.4.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/04/2021] [Indexed: 11/07/2022] Open
Abstract
Objectives Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. Materials and Methods Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. Results Groups A and B did not differ significantly in any extraoral or intraoral parameter. Conclusion The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in com-plete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
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Affiliation(s)
- Ritesh Kalaskar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Bhaje
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Sharma
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Shruti Balasubramanian
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Nupur Ninawe
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Rajesh Ijalkar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
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Huang L, Wang Z, Shan Z, Yeung AWK, Yang Y, Liang Z, Gu M. Nasal asymmetry changes during growth and development in 6- to 12-year-old children with repaired unilateral cleft lip and palate: A 3D computed tomography analysis. J Anat 2021; 240:155-165. [PMID: 34411284 PMCID: PMC8655196 DOI: 10.1111/joa.13538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022] Open
Abstract
Repaired unilateral cleft lip and palate (UCLP) is often accompanied by the deformity and asymmetry of the nasal region. Three‐dimensional analysis was performed to investigate the relationship between nasal soft‐ and hard‐tissue asymmetries, as well as the changes in nasal asymmetry with age, among children with repaired UCLP (age: 6–12 years). Forty‐seven patients were included in this study. Their computed tomography records were retrieved for analysis of the 3D asymmetry of 10 landmarks of the nasal soft and hard tissues. We observed that asymmetry was more severe in nasal hard tissues than in soft tissues, particularly in the sagittal dimension. Compared with patients aged 6–9 years old, patients aged 10 to 12 years old had significantly increased vertical asymmetry at the base of the alar groove (Gbase, p = 0.027) and the lateral point of the piriform aperture (LPA), (p < 0.001). The correlation between the LPA and the alar region was weak to moderate (r = 0.290 to 0.488). In conclusion, we found no evidence of growth and development in nasal hard‐tissue asymmetry among 6‐ to 12‐year‐old children with repaired UCLP, except for the vertical dimension. Nasal soft tissue exhibited a more preferable symmetry than hard tissue, and this could be attributed to the compensatory growth of nasal soft tissue, particularly in the vertical and sagittal dimensions. The weak to moderate correlations between nasal soft‐tissue asymmetry and hard‐tissue asymmetry were observed in the three dimensions. Surgeons should consider these factors when repositioning the nasal alar and controlling the size of the nostrils.
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Affiliation(s)
- Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Guangdong, P.R. China.,Department of Stomatology, Shenzhen Second People's Hospital, Guangdong, P.R. China
| | - Ziling Wang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Zhiyi Shan
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Andy Wai Kan Yeung
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Yanqi Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Guangdong, P.R. China
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R., China
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Bonanthaya K, Jalil J, Sasikumar AV, Shetty PN. Furlow Palatoplasty for Velopharyngeal Dysfunction Management: Auditing and Predicting Outcomes. Cleft Palate Craniofac J 2021; 59:1097-1106. [PMID: 34402312 DOI: 10.1177/10556656211035914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Furlow palatoplasty is a proven procedure in the management of secondary velopharyngeal dysfunction in patients with cleft palate. But the selection of cases, the degree of clinical success, and the preoperative predictors of the same are less established. This study is an effort to retrospectively look at outcomes, in a large series of velopharyngeal dysfunction cases treated with the Furlow palatoplasty alone. DESIGN Retrospective analysis of preoperative and postoperative speech and videofluoroscopic data. SETTING Tertiary care center. PATIENTS/PARTICIPANTS Ninety-two patients who were diagnosed with velopharyngeal dysfunction post primary cleft palate repair. INTERVENTIONS Furlow palatoplasty for velopharyngeal dysfunction post primary cleft palate repair. MAIN OUTCOME MEASURES Variables analyzed were perceptual speech parameters and, closure ratios obtained from lateral video-fluoroscopic images. RESULTS Overall, 81.5% had postoperative improvements in their lateral video-fluoroscopic parameters, 63% improved their nasality scores, and 65.2% had improved speech intelligibility. A simple linear regression was done to predict the postoperative closure ratio. Preoperative closure ratio, hypernasality (moderate and severe), and audible nasal air emission are predictors for postoperative closure ratio. CONCLUSIONS The Furlow palatoplasty alone led to complete resolution, or significant improvement of velopharyngeal dysfunction in a majority of patients, despite the cohort having a wide range of severity in terms of degree of dysfunction. The predictive formula will be validated in a further study.
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Affiliation(s)
| | - Jazna Jalil
- Bhagwan Mahaveer Jain Hospital, Bengaluru, India
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The Effectiveness of Preoperative Correction Techniques in Improving Nasal Deformity in Children With Unilateral Complete Cleft Lip and Palate. J Craniofac Surg 2021; 32:664-669. [PMID: 33705005 DOI: 10.1097/scs.0000000000007145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Unilateral complete cleft lip and palate (UCCLP) is associated with apparent nasal deformities before the cheilorrhaphy. The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral UCCLP used by the systematic review and meta-analysis. METHODS We searched Medline, Cochrane Library, EMBASE, PubMed, and Chinese BioMedical Literature Database (CBM) until January 31, 2019, to identify studies that compared the effectiveness of preoperative correction techniques in the treatment of nasal deformities in infant with UCCLP. Two authors individually extracted the data and performed the quality assessments. The height of nasal columella, the width of the affected side nasal ala and the inclination of the nasal columella were evaluated. RESULTS Seven articles were incorporated into the systematic review, and 5 (274 participants) in the meta-analysis according to the inclusion criteria. The preoperative correction could increase the height of nasal columella in children with UCCLP [SMD: 2.64 mm; 95% confidence intervals (CI); (1.35 mm, 3.94 mm); P < 0.0001]. Moreover, the preoperative correction resulted in reduced width of the affected side nasal ala [SMD: -5.14 mm; 95% CI; (-8.96 mm, -1.31 mm); P = 0.008]; However, the evidence was insufficient to determine a significant effect on the inclination of the nasal columella [SMD: -3.48 degrees; 95% CI; (-7.56 degrees, 0.59 degrees); P = 0.09]. CONCLUSIONS Preoperative correction for children with UCCLP can increase the height of nasal columella, reduce the width of the affected side nasal ala, improve the nasal symmetry, and reduce nasal deformity, however, no significant effect could be observed for the inclination of the nasal columella.
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35
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Presurgical Orthopedic Intervention Prior to Cleft Lip and Palate Repair: Nasoalveolar Molding Versus Passive Molding Appliance Therapy. J Craniofac Surg 2021; 32:486-491. [PMID: 33704966 DOI: 10.1097/scs.0000000000006929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nasoalveolar molding (NAM) is a widely used presurgical orthopedic device, despite disputes over its effectiveness. This study compares the outcomes after cleft lip and nose repair in patients who received NAM versus those who underwent passive alveolar molding with lip taping. METHODS A retrospective review of patients with complete unilateral cleft lip and palate who received either NAM (n = 16) or passive molding (n = 10) treatments was conducted. Alveolar gap width was measured on maxillary casts until time of palatoplasty. Nasolabial symmetry was assessed by examining anthropometric ratios on post-operative three-dimensional photographs. Burden of care was evaluated by analyzing the number of patient appointments attended, treatment costs, and caregiver satisfaction surveys. RESULTS No statistically significant difference existed in alveolar gap at time of initial appointment or palatoplasty, however the gap was smaller in the NAM cohort at time of lip and nose repair. No statistically significant difference existed in postsurgical heminasal width, nostril width, nostril height, labial height or nasal ala projection asymmetry between the NAM and the passive molding cohort. Patients in the NAM group attended more dental appointments and incurred higher treatment costs compared to the passive molding group. Caregivers reported high satisfaction with treatment outcomes in both cohorts. CONCLUSIONS There were no differences between NAM and passive molding regarding postsurgical nasolabial appearance and patient satisfaction. Both treatments narrow the alveolar gap. However, NAM places a higher burden of care on families.
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Mancini L, Avinoam S, Grayson BH, Flores RL, Staffenberg DA, Shetye PR. Three-Dimensional Nasolabial Changes After Nasoalveolar Molding and Primary Lip/Nose Surgery in Infants With Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2021; 59:475-483. [PMID: 34032145 DOI: 10.1177/10556656211012858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery. DESIGN This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with x, y, z coordinates to obtain the linear and angular measurements. Nasal form changes were measured and analyzed between T1 (0.5 months old), T2 (5 months old), and T3 (6 months old). Intraclass correlation coefficient was performed for intrarater reliability. Averaged data from the 3D images was statistically analyzed from T1 to T2 and T2 to T3 with Wilcoxon tests. Unaffected infant norms from the Farkas publication were used as a control sample. RESULTS After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip's projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM. CONCLUSIONS There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.
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Affiliation(s)
- Laura Mancini
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
| | - Shayna Avinoam
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
| | - Barry H Grayson
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjorg Wyss Department of Plastic Surgery, 12297New York University Langone Health, New York, NY, USA
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Three-dimensional imaging technique to compare digital impression CEREC Omnicam intraoral camera (CAD) and tri-dimensional cone-beam computed tomography, to measure maxillary casts: Unilateral and bilateral cleft lip and palate up to 6 months of age, applied in nanotechnology. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-01846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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NAM-help or burden? Intercultural evaluation of parental stress caused by nasoalveolar molding: a retrospective multi-center study. Clin Oral Investig 2021; 25:5421-5430. [PMID: 33665684 PMCID: PMC8370945 DOI: 10.1007/s00784-021-03850-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 11/14/2022]
Abstract
Objectives Nasoalveolar molding (NAM) was developed to facilitate easier treatment and better outcomes for cleft lip and palate (CLP) patients. The aim of this study was to investigate the parental burden and possible intercultural differences of this treatment modality, which is often argued to burden parents to an extraordinary amount. Materials and methods Standardized questionnaires (available in English, Mandarin, and German) with 15 non-specific and 14 NAM-specific items to be retrospectively answered by Likert scales by parents of unilateral CLP patients with completed NAM treatment. Results The parents of 117 patients from two treatment centers in Taiwan and Germany were included. A very high level of overall satisfaction was found in both countries with significant intercultural differences in prenatal parent information, feeding problems, dealing with 3rd party’s perception, and experienced personal effort. Conclusion NAM is an effective treatment tool for children’s CLP deformities and their caregivers in overcoming the feeling of helplessness. Intercultural differences may be due to infrastructural reasons, cultural attitudes and habits, or different public medical education. Clinical relevance In addition to facilitating easier surgical treatment, NAM can be seen as a powerful coping strategy for parents dealing with a CLP deformity of their child and does not seem to burden them extraordinarily.
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Tankittiwat P, Pisek A, Manosudprasit M, Punyavong P, Manosudprasit A, Phaoseree N, Wangsrimongkol B, Pisek P, Manosudprasit A. Function of Nasoalveolar Molding Devices in Bilateral Complete Cleft Lip and Palate: A 3-Dimensional Maxillary Arch Analysis. Cleft Palate Craniofac J 2021; 58:1389-1397. [PMID: 33657892 DOI: 10.1177/1055665621990184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to observe and analyze the effects of nasoalveolar molding (NAM) on maxillary arch dimensions in patients with bilateral complete cleft lip and palate (BCLP) using 3-dimensional analyses. DESIGN Retrospective case series. MATERIALS AND METHODS Seventeen infants were treated using modified Khon Kaen University presurgical nasoalveolar molding devices (KKU-NAM). Dental casts were evaluated 3 dimensionally at 3 time points: pretreatment (T1), after using modified KKU-NAM for 2 weeks (T2), and before cheiloplasty (T3). Repeated-measures analysis of variance and Friedman test were used to compare the maxillary arch dimensions between time points. RESULTS Both sides of the cleft width, premaxilla deviation, and premaxilla protrusion had significantly reduced with the use of KKU-NAM. Premaxillary rotation had significantly improved, whereas the arch depth did not change significantly. Premaxilla width, posterior arch width, alveolar length, and height had significantly increased. The anterior arch width, intercanine width, and lateral sulcus width showed no significant changes. The intraclass correlation coefficient used to test the measurements indicated substantial reliability. CONCLUSION The modified KKU-NAM is an effective device for reducing the severity of bilateral cleft deformities, especially in the premaxilla area.
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Affiliation(s)
- Pawinee Tankittiwat
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Araya Pisek
- Faculty of Dentistry, Division of Dental Public Health, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Montien Manosudprasit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Pattama Punyavong
- Faculty of Medicine, Plastic and Reconstructive Unit, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Amornrut Manosudprasit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Natthawee Phaoseree
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Buddhathida Wangsrimongkol
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Poonsak Pisek
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Aggasit Manosudprasit
- Faculty of Dentistry, Division of Orthodontics, Department of Preventive Dentistry, Khon Kaen University, Khon Kaen, Thailand
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Variational Characteristics of Nasolabial Appearance and Its Influencing Factors for the Unilateral Cleft Lip Repair With Modified Huaxi Technique. J Craniofac Surg 2021; 32:1094-1098. [PMID: 33587527 DOI: 10.1097/scs.0000000000007536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE After many years in clinical practice, the authors found that the long-term aesthetics of the upper lip and nose following repair of a unilateral cleft lip deformity using the Huaxi method remained unsatisfactory. The immediate postoperative effect was often good, while the long-term postoperative effect was poor. Therefore, this study aimed to evaluate the characteristics and influencing factors of a modified Huaxi method for repairing unilateral cleft lip over time, and to explore the relationship between immediate and long-term outcomes after cleft lip surgery. METHODS Patients with unilateral cleft lip who visited the Department of Maxillofacial Surgery of the Stomatological Hospital of Zunyi Medical University from June 2014 to March 2016 were selected. The study group consisted of 51 consecutive patients (30 boys and 21 girls), aged between 3 months and 2 years. Of these, 24 presented with complete unilateral cleft lip (12 wore a nasoalveolar mold as required, 12 did not) and 27 with incomplete unilateral cleft lip (13 wore a nasoalveolar mold as required, 14 did not). Photographs were taken of 51 patients before surgery and immediately, 7 days, and 6 months postoperatively. Various indexes of nasolabial contour of each patient were measured using iWitness photogrammetry, and the slit width; lip height ratio, lip width ratio, nostril width ratio, and nostril height ratio of the healthy side; and degree of deviation of the nasal columella were calculated. RESULTS Long-term symmetry of lip height and width remained stable postoperatively (P > 0.05), whereas nostril height symmetry was significantly reduced (P > 0.05). Nasal width symmetry and midpoint deviation of the nasal columella were stable in patients with nasoalveolar molding (P > 0.05), but significantly decreased in patients without nasoalveolar molding (P < 0.05). In patients with complete unilateral cleft lip, there was a significant correlation between fissure width and lip width symmetry 6 months postoperatively (r = 0.431, P < 0.05). CONCLUSIONS The symmetry of the upper lip is satisfactory and stable following surgical repair with the modified Huaxi technique. However, undercorrection of nasal symmetry is commonplace. Fissure width and nasoalveolar molding may influence long-term aesthetics following unilateral cleft lip repair.
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Galassi TV, Souza-Brosco TV, Lopes LD, de Almeida AM, da Silva Dalben G, de Paiva JB, Neto JR, Ozawa TO. Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)? Cleft Palate Craniofac J 2021; 58:1265-1273. [PMID: 33486979 DOI: 10.1177/1055665620984352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate. MATERIAL AND METHODS Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test (P < .05). RESULTS Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test (P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index (P = .019). CONCLUSIONS Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.
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Affiliation(s)
- Thalita V Galassi
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Telma V Souza-Brosco
- Plastic Surgery Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Lucy D Lopes
- Department of Prosthodontics, Faculty of Dentistry, University of Sao Paulo, Brazil
| | - Araci Malagodi de Almeida
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Gisele da Silva Dalben
- Pediatric Dentistry Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Joao B de Paiva
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - José Rino Neto
- Department of Orthodontics and Pediatrics, Faculty of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Terumi O Ozawa
- Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
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A Three-Dimensional Study of the Nasolabial Soft Tissue Symmetry in Children With Unilateral Complete Cleft Lip and Palate Using Traditional and Split-Type Nasoalveolar Molding. J Craniofac Surg 2021; 31:1785-1789. [PMID: 32569046 DOI: 10.1097/scs.0000000000006593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Presurgical nasoalveolar molding (NAM) is the most common preoperative treatment for cleft lip and palate. However, NAM may have some limitations such as requiring high technical sensitivity and frequent visits. To simplify the device, some scholars have changed the traditional NAM into a split-NAM consisting of a alveolar molding plate and a nasal hook. This study compared the shaping effect of split NAM and traditional NAM on nasolabial soft tissue using three-dimensional (3D) measurement. METHODS A total of 39 patients with unilateral cleft lip and palate (UCLP) were enrolled and divided into 2 groups. 13 patients were treated with split-NAM while the other 26 patients were treated with traditional NAM. 3D images of all patients' craniofacial soft tissue before and after NAM treatment were recorded and measured by three-dimensional software. Statistical analysis of measurements in both groups was performed using SPSS software. RESULTS After treatment, nasal soft tissue symmetry in the split-NAM group was better improved than that in the NAM group in vertical and anterior-posterior direction, but was worse improved in transverse direction. There was no significant difference in labial soft tissue symmetry between two groups. CONCLUSIONS The split NAM can better elevate the alar and nostrils of the cleft side, and have a better forward effect on alar outer edge, nasal base, and nostrils. However, the traditional NAM can better reduce the width of nasal base.
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Primary Cleft Rhinoplasty: Surgical Outcomes and Complications Using Three Techniques for Unilateral Cleft Lip Nose Repair. J Craniofac Surg 2021; 31:1521-1525. [PMID: 31764569 DOI: 10.1097/scs.0000000000006043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study represents a single surgeon's 10 years of experience addressing unilateral cleft lip and palate nose deformity. The purpose was to compare surgical outcomes and related complications using 3 different techniques to improve nasal shape in primary unilateral cleft rhinoplasty. METHODS This retrospective study with Institutional Ethical Committee approval compares 3 groups of patients with unilateral cleft lip nose and palate who were operated on using different techniques from 2007 to 2017. Surgical outcomes were analyzed by physical examination at least 1 year after primary rhinoplasty. Anthropometric measurements were obtained for the cleft and noncleft sides of the nose. RESULTS Approach with general analysis indicated differences among the 3 techniques. The author's comparative study revealed differences in nose symmetry and related complications, including increased recurrence of nose deformity using the modified McComb technique. Better short-term nose symmetry was observed using Potter technique and the V-Y-Z rhinoplasty. CONCLUSIONS Potter approach and the V-Y-Z techniques achieve better short-term nose symmetry than the McComb method. Complications were less common in the group of patients operated on using the modified McComb technique. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty using the proposed methods.
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Al Khateeb KA, Fotouh MA, Abdelsayed F, Fahim F. Short-Term Efficacy of Presurgical Vacuum Formed Nasoalveolar Molding Aligners on Nose, Lip, and Maxillary Arch Morphology in Infants With Unilateral Cleft Lip and Palate: A Prospective Clinical Trial. Cleft Palate Craniofac J 2020; 58:815-823. [PMID: 33107321 DOI: 10.1177/1055665620966189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the short-term effect of series of preadjusted vacuum formed nasoalveolar molding VF NAM aligners on the morphology of nose, lip, and maxillary arch in infants with unilateral cleft lip and palate (UCLP). DESIGN Prospective clinical trial. SETTING Unilateral cleft lip and palate patients referred to outpatients' clinic. PATIENTS Sixteen nonsyndromic infants with UCLP, less than 2 months of age were included from April 2017 to April 2018. INTERVENTIONS All infants received VF NAM therapy. Standardized digital frontal and basilar photographs and 3D digital models were taken before initiation of VF NAM therapy (T1) and after completion of VF NAM therapy (T2). MAIN OUTCOME MEASURE(S) Changes in morphology of the nose, lip, and maxillary arch. RESULTS Statistical analysis comparing T1 and T2 measurements was performed. Frontal and basilar photographic analysis showed a statistically significant reduction of columella displacement, interlabial gap distance, and nostril width at cleft side (CS), while the nasal height, nostril height at CS, nostril width at noncleft side (NCS), columella deviation angle, nasal tip protrusion, and nostril area at both CS and NCS increased significantly with VF NAM therapy. The nasal width, nostril height at NCS showed no significant change after presurgical VF NAM aligners therapy. The analysis of digital models demonstrated a statistically significant reduction of alveolar cleft width, anterior arch width, arch length, midline deviation, and palatal cleft width, while the posterior arch width and arch perimeter increased significantly with VF NAM therapy. CONCLUSION Vacuum formed NAM therapy was effective in reducing the nasoalveolar deformities associated with infants with UCLP and improved the alveolar morphology and nasal symmetry.
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Affiliation(s)
| | - Mai Aboul Fotouh
- Department of Orthodontics, Faculty of Dentistry, 63526Cairo University, Cairo, Egypt
| | - Fatma Abdelsayed
- Department of Orthodontics, Faculty of Dentistry, 63526Cairo University, Cairo, Egypt
| | - Fady Fahim
- Department of Orthodontics, Faculty of Dentistry, 63526Cairo University, Cairo, Egypt
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Wu M, Shi B. [Application of nasal clip in the one-stage repair of unilateral cleft lip nasal deformity]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:546-549. [PMID: 33085240 DOI: 10.7518/hxkq.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the application of nasal clip in the one-stage repair of unilateral cleft lip nasal deformity. METHODS Sixty patients with unilateral cleft lip nasal deformity underwent one-stage repair in the Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, from January 2017-June 2018. Sixty patients were divided into three groups, nasal clip group, the nasal module group, and the control group. All of the patients were returned to the clinic after the operation (6-12 months), and the nasal appearance was evaluated. RESULTS The nasal shape development and aesthetic effect in the nasal clip group were significantly improved than that in the control group (P<0.05). CONCLUSIONS The nasal clip has a good effect on the improvement of nasal appearance after the one-stage repair of unilateral cleft lip nasal deformity. The nasal clip is easy to operate, and the patient compliance is good, which is worthy of clinical promotion.
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Affiliation(s)
- Min Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3082. [PMID: 33133938 PMCID: PMC7544269 DOI: 10.1097/gox.0000000000003082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
Background: The purpose of this study was to evaluate the surgical outcome after using primary surgery to address bilateral cleft lip nose and palate deformities. In addition, the authors performed a systematic review to evaluate the effects of the nasoalveolar molding on non-syndromic bilateral cleft lip and palate. Methods: A prospective cohort study on a surgeon’s surgical outcome of 25 consecutively performed primary bilateral cleft lip nasal deformity repairs was conducted and a systematic review of the literature for studies published until December 2019 was done to evaluate the effect of presurgical NAM on nasolabial aesthetics and alveolar gap. Results: Since 2014, 25 consecutive patients with complete bilateral cleft have undergone primary anatomical repair of the cleft nasal deformity using primary cheilorhinoplasty. The average columella length was 4.3 ± 1.3 mm. The average ratio of the columella height to nasal height was 0.48 mm 1 year postoperatively and 0.52 mm 5 years postoperatively. Statistically significant differences have been observed between the pre and postoperative alveolar and palatal gaps after using primary cheiloplasty or bilateral lip adhesion. After systematic literature searching, 14 identified studies were qualified for the final analysis, which included 433 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. Conclusions: The results of this study suggest that the proposed primary cheilorhinoplasty is a good alternative to improve nose appearance and alveolar gap in patients with primary bilateral cleft lip nose and palate deformity. Based on the available scientific evidence, definitive conclusions about the effectiveness of presurgical Naso Alveolar Molding on nasolabial aesthetics cannot be drawn. Quality of the included articles were too low to make a conclusion.
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Maliha SG, Kantar RS, Gonchar MN, Eisemann BS, Staffenberg DA, Shetye PR, Grayson BH, Flores RL. The Effects of Nasoalveolar Molding on Nasal Proportions at the Time of Nasal Maturity. Cleft Palate Craniofac J 2020; 58:284-289. [PMID: 32851868 DOI: 10.1177/1055665620950139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity. METHODS A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners. RESULTS Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM. CONCLUSION The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.
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Affiliation(s)
- Samantha G Maliha
- Department of Plastic Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Marina N Gonchar
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Bradley S Eisemann
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Barry H Grayson
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, New York, NY, USA
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Nayak T, Parmar R, Bonanthaya K, Shetty P. A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding. Indian J Plast Surg 2020; 53:371-376. [PMID: 33402767 PMCID: PMC7775234 DOI: 10.1055/s-0040-1714768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background
Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven.
Methods
In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments.
Results
In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up.
Conclusion
Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.
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Affiliation(s)
- Tulasi Nayak
- Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences, Jayanagar, Bengaluru, India
| | - Renu Parmar
- Department of Oral and Maxillofacial Surgery, Smile Train Cleft Centre, Bhagwan Mahaveer Jain Hospital, Bangalore
| | - Krishnamurthy Bonanthaya
- Department of Oral and Maxillofacial Surgery, Smile Train Cleft Centre, Bhagwan Mahaveer Jain Hospital, Bangalore
| | - Pritham Shetty
- Department of Oral and Maxillofacial Surgery, Smile Train Cleft Centre, Bhagwan Mahaveer Jain Hospital, Bangalore
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49
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Denadai R, Chou PY, Jung S, Sato N, Pascasio DCG, Lo LJ. A Surgical and Educational Video of the Inferior Turbinate Mucosal Flap for the Nasal Floor and Intraoral Reconstruction in Unilateral Complete Cleft Lip Repair. Cleft Palate Craniofac J 2020; 57:1045-1050. [PMID: 32138549 DOI: 10.1177/1055665620910046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since the original description of Millard rotation advancement principle for cleft lip repair, many important contributions have subsequently been described by other surgeons worldwide. However, the reconstruction of the nasal floor and intraoral lining has received less attention over time. This article demonstrates a modified unilateral complete cleft lip repair using the rotation advancement principle plus multipurpose inferior turbinate mucosal flap. The accompanying videos display the 10 key steps for rationale, design, and proper execution of the inferior turbinate mucosal flap for the nasal floor and intraoral reconstruction.
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Affiliation(s)
- Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Soyeon Jung
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Dax Carlo G Pascasio
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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50
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Bonanthaya K, Jalil J. Management of the Nasal Deformity in the Unilateral Cleft of the Lip and Nose. J Maxillofac Oral Surg 2020; 19:332-341. [PMID: 32801524 DOI: 10.1007/s12663-020-01412-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Abstract
Cleft rhinoplasty is a demanding, technique-sensitive procedure. Part art, part science; it poses several probing questions to the surgeon. The unilateral cleft nasal deformity is a distinct entity because the pursuit of symmetry in the unilateral cleft nose makes the repair much more challenging. The advent of nasoalveolar moulding, the gaining popularity of primary (early) nasal repair and greater refinements in secondary (definitive) rhinoplasty techniques have contributed to better nasal results in unilateral cleft repair. Yet, some obstacles remain. This paper aims to discuss the anatomy of the unilateral cleft nose, enumerate aims and objectives of repair at every stage, and to demonstrate the evolution and varied rationale of management of nasal deformities in the unilateral cleft lip and nose.
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Affiliation(s)
| | - Jazna Jalil
- Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
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