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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Zheng J, Kuang W, Yuan S, He H, Yuan W. Three-dimensional Analysis of Maxillary Morphology in Infants with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2024:10556656241228903. [PMID: 38414427 DOI: 10.1177/10556656241228903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE To three-dimensionally (3D) analyze the maxillary morphology of infants with unilateral cleft lip and palate (UCLP) and preliminarily classify the alveolar arch to assist in personalization of sequence therapy. DESIGN Retrospective study. SETTING Patients with UCLP referred to outpatients' clinic. PARTICIPANTS 84 nonsyndromic infants with complete UCLP were recruited (58 boys, 26 girls, mean age 29.48 days). MAIN OUTCOME MEASURE Morphometric analysis was conducted on 3D maxillary models. Principal component analysis (PCA) and cluster analysis were combined to classify maxillary phenotypes preliminarily. The Wilcoxon Signed Rank test and the Kruskal-Wallis test were used to compare differences between variables. A P value less than .05 was considered statistically significant. RESULTS The maxilla was divided into three types: narrow, homogenous and broad, accounting for 9.52%, 23.81% and 66.67% respectively. The alveolar cleft site (median value) was located in 61% of the total length of the alveolar arch. In the comparison of anterior and total alveolar lengths, the non-cleft side had longer alveolar bone than the affected side, a difference of approximately 2 mm. Pairwise comparisons of variables describing alveolar symmetry revealed significant differences in all subjects; whereas type C had poorer arch symmetry than types A and B, mainly in terms of anterior and overall symmetry. CONCLUSIONS In infants with UCLP, the maxillary alveolar arch was inherently asymmetrical with partially bone missing (about 2 mm). Significant differences in alveolar bone morphology and symmetry exist between different types of infants, with individuals with broad clefts (type C, the largest proportion) having the worst maxillary development.
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Affiliation(s)
- Jie Zheng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenying Kuang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Shiyu Yuan
- School of Clinical Medicine, Zhengzhou University, Zhengzhou, China
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenjun Yuan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
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Yin J, Zhang S, Huang N, Shi B, Zheng Q, Yang C. Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study. Front Pediatr 2022; 10:1101184. [PMID: 36644403 PMCID: PMC9837100 DOI: 10.3389/fped.2022.1101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP). METHODS Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups. RESULTS In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm. CONCLUSION Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height.
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Affiliation(s)
- Jiayi Yin
- 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, China
| | - Shiming Zhang
- 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, China
| | - Ning Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing 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, China
| | - Qian Zheng
- 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, China
| | - Chao Yang
- 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, China
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Abstract
OBJECTIVE This is a prospective study examining palatal casts from patients with unilateral cleft lip and palate (UCLP) in the first month of life, immediately before cheiloplasty, and immediately before palatoplasty. None of the patients receives presurgical orthopedics (nasoalveolar molding). DESIGN In this prospective study, upper arch plaster models were taken 3 times during the treatment: in the first month of life (T1), before the cheiloplasty (T2), and before the palatoplasty (T3). Anatomic landmarks were defined and linear anthropometric measurements were obtained afterward. Dimensional analysis was performed using 3D software. Two-way analysis of variance followed by Tukey test was performed for statistical analysis. SETTING Tertiary, institutional. PARTICIPANTS Twelve patients with UCLP of either sex with less than 1 month of life and without any other syndrome. INTERVENTION No intervention was performed. MAIN OUTCOME MEASURE Reduction of the cleft without using orthopedics apparatus. RESULTS There was a statistically significant reduction in the cleft gap comparing T1 to T3. There was also a significant reduction in the intercanine width comparing T2 and T3, and T1 and T3. There was significant increase in the posterior arch width comparing T2 and T3, and T1 and T3. The palatal plate's width increased in all times analyzed. CONCLUSION The palatal cleft narrows spontaneously as well in both midpoint and posterior point during the first 6 months of patient's treatment. This event was enhanced by cheiloplasty. This surgery might have a greater influence on the anterior arch width than in the posterior arch region.
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Affiliation(s)
| | | | - Renato da Silva Freitas
- Plastic Surgery Unit, Department of Surgery, School of Medicine, Federal University of Parana (UFPR), Curitiba, Brazil
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Thakur S, Jishad C, Singhal P, Chauhan D. Comparative clinical evaluation of modified and conventional Grayson's presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.324027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bruggink R, Baan F, Kramer GJC, Kuijpers-Jagtman AM, Bergé SJ, Maal TJJ, Ongkosuwito EM. Symmetry of palatal shape during the first year of life in healthy infants. Clin Oral Investig 2020; 25:1069-1076. [PMID: 32583240 PMCID: PMC7878251 DOI: 10.1007/s00784-020-03403-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
Objectives The purpose of this study was to quantify the symmetry of the alveolar process of the maxilla and palate during the first year of life in healthy infants with the help of a semiautomatic segmentation technique. Materials and methods Maxillary plaster models of seventy healthy babies at 0, 3, 6, 9, and 12 months were collected and digitized. A semiautomatic segmentation tool was used to extract the alveolus and palate. The resulting model was aligned within a reference frame and mirrored on its medial plane. Distance maps were created and analyzed to compare and quantify the differences between the two hemispheres. Additional hemispherical width and area measurements were performed. An ANOVA test with additional post hoc tests was performed to check if the symmetry changed during development. Finally, the results were tested on intra- and interobserver variability. Results The absolute mean inter-surface distance between the original and mirrored models in each age group ranged between 0.23 and 0.30 mm. Width and area analysis showed a small but significant larger left palatal hemisphere. ANOVA and post hoc tests showed no significant difference in symmetry between groups. Reliability analysis showed no significant differences between observers. Conclusions This study showed that in this infant population, only a small degree of palatal asymmetry was present, which can be considered as normal and clinically irrelevant. Clinical relevance The data from this study can be used in future comparative studies as reference data. Furthermore, modeling of these data can help in predicting the growth pattern, which may lead to improved treatment protocols for children with craniofacial anomalies. Electronic supplementary material The online version of this article (10.1007/s00784-020-03403-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Bruggink
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands. .,3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - F Baan
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - G J C Kramer
- Alkmaarse Orthodontisten, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JB, Alkmaar, The Netherlands
| | - A M Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Hochschulstrasse 4, 3012, Bern, Switzerland.,Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Amalia Cleft And Craniofacial Centre, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - T J J Maal
- 3D Lab Radboudumc, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - E M Ongkosuwito
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Amalia Cleft And Craniofacial Centre, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Abstract
Nasoalveolar molding (NAM) is a powerful tool in the treatment of patients with unilateral or bilateral cleft lip and palate. The primary goal of NAM is to improve alignment of critical anatomic elements before surgical repair of the unilateral or bilateral cleft lip. Modifications of the position of the alveolar segments and their associated lip elements, the lower lateral cartilages, and the columella achieved with NAM are helpful for creating a suitable platform for tension-free lip repair.
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Affiliation(s)
- Hitesh Kapadia
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA.
| | - Douglas Olson
- Craniofacial Center of Western New York, Oishei Children's Outpatient Center, 1001 Main Street, Buffalo, NY 14203, USA
| | - Raymond Tse
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA
| | - Srinivas M Susarla
- Seattle Children's Hospital, Craniofacial Center, 4800 Sand Point Way Northeast, Seattle, WA 98145, USA
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Bhutiani N, Tripathi T, Verma M, Bhandari PS, Rai P. Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability. Cleft Palate Craniofac J 2020; 57:700-706. [PMID: 32116001 DOI: 10.1177/1055665620906293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. DESIGN Prospective clinical trial. SETTING Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. PATIENTS Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. INTERVENTIONS Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. MAIN OUTCOME MEASURES Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. RESULTS There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. CONCLUSIONS Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.
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Affiliation(s)
- Neha Bhutiani
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Mahesh Verma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | | | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Zheng J, He H, Kuang W, Yuan W. Novel Three-Dimensional Coordinate System to Analyze Alveolar Molding Effects of Pre-Surgical Nasoalveolar Molding on Infants With Non-Syndromic Unilateral Cleft Lip and Palate. J Craniofac Surg 2020; 31:653-7. [PMID: 31985599 DOI: 10.1097/SCS.0000000000006148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to establish a stable 3-dimensional (3D) coordinate system for investigating the alveolar molding effects of pre-surgical nasoalveolar molding (PNAM) on non-syndromic unilateral cleft lip and palate (UCLP) patients, basing on the Frankfort Horizontal (FH) plane.Twenty-one non-syndromic UCLP neonates who sought medical advice in the department of Orthodontics, from 2016.5 to 2017.10 were enrolled in the present study. All neonates were subjected to PNAM before the cleft lip repair. The treatment duration was 75.76 days. Silicone rubber models were obtained and scanned using a 3D laser scanner pre- and post-PNAM treatment. A 3D coordinate system based on the FH reference plane was built utilizing Rhino3D software to record the landmark 3D coordinates, to measure the distance, angle, and length variables. The Paired Student's t test and the Pearson correlation coefficient were used to calculate reproducibility and reliability of the landmark localization for repeated measurements. Changes of the measurement variables were analyzed by the Paired Student's t test.This study revealed a high reproducibility and reliability for most of the landmarks. By the end of PNAM treatment, the cleft gap was reduced with the malformation of alveolar segments aligned normally and the anterior points of both alveolar segments were rotated to the cleft side.Utilizing the FH plane to set up a rigorous and stable 3D system is meaningful. PNAM therapy is effective in reducing the severity of the maxillary deformity not only on the non-cleft side, but also on the cleft side.
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Zheng J, He H, Kuang W, Yuan W. Presurgical nasoalveolar molding with 3D printing for a patient with unilateral cleft lip, alveolus, and palate. Am J Orthod Dentofacial Orthop 2019; 156:412-419. [PMID: 31474271 DOI: 10.1016/j.ajodo.2018.04.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 11/19/2022]
Abstract
An 8-day-old male infant with unilateral cleft lip, alveolus, and palate had a wide alveolar defect, soft tissue deformity, and a markedly sunken nasal wing at the cleft side. The patient was treated with a series of 3D-printed molding plates and synchronously with a nasal hook. The cleft edges moved closer by 9 mm at the alveolar ridge and the nasal wing was lifted considerably. Split-type 3D printing of presurgical nasoalveolar molding helped to reduce the cleft gap, improve the arch form, approximate lip segments, and distinctly improve the morphology of the nose by correcting the flattened nasal wings.
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Affiliation(s)
- Jie Zheng
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenying Kuang
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wenjun Yuan
- Department of Orthodontics, School and Hospital of Stomatology, State Key Laboratory Breeding Base of Basic Science of Stomatology, and Key Laboratory for Oral Biomedicine of Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China.
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Staderini E, Patini R, Camodeca A, Guglielmi F, Gallenzi P. Three-Dimensional Assessment of Morphological Changes Following Nasoalveolar Molding Therapy in Cleft Lip and Palate Patients: A Case Report. Dent J (Basel) 2019; 7:E27. [PMID: 30866516 DOI: 10.3390/dj7010027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/25/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022] Open
Abstract
The applications of computer-guided technologies for three-dimensional image analysis provide a unique opportunity to quantify the morphological dimensional changes of the face in a practical and convenient way. Symmetry of the nasolabial area is one of the main factors of facial attractiveness as well as being the main objective of the treatment of cleft lip and palate (CLP). Technological advances in computer-guided visualization modes and their applications to three-dimensional stereophotogrammetry provide more practical opportunities and alternatives for facial analysis. Each study, however, uses different protocols for the acquisition and analysis of three-dimensional images. In addition, each study identifies different anthropometric points and calculates linear and angular measurements with overlapping protocols. Therefore, it is appropriate to define a standardization of the three-dimensional analysis of CLP patients to compare the studies of different research centers. The aim of this report is to propose a protocol to standardize the acquisition and analysis of three-dimensional images to evaluate the three-dimensional changes in the nasolabial area in cleft lip and palate patients undergoing pre-surgical nasoalveolar molding (PNAM).
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Nur Yilmaz RB, Germeç Çakan D. Nasolabial Morphology Following Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:1012-6. [PMID: 29489580 DOI: 10.1097/SCS.0000000000004427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate. METHODS Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test. RESULTS All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P < 0.05). No differences were present between linear and surface distance measurements except for nasal width measurement. CONCLUSIONS Nasal and lip symmetry improved with NAM. The use of surface distance measurements may be advised particularly for continuous and curved anatomic structures in which circumference differences are expected.
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Ambrosio ECP, Sforza C, De Menezes M, Carrara CFC, Machado MAAM, Oliveira TM. Post-surgical effects on the maxillary segments of children with oral clefts: New three-dimensional anthropometric analysis. J Craniomaxillofac Surg 2018; 46:1511-1514. [PMID: 30029840 DOI: 10.1016/j.jcms.2018.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/02/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022] Open
Abstract
This study aimed to use new three-dimensional (3D) anthropometric analyses to verify the post-surgical effects on the maxillary segments of children with unilateral cleft lip and palate. The sample was composed by digitized dental models of 60 children with unilateral complete cleft lip and alveolus (UCLA) and complete unilateral cleft lip and palate (UCLP). The impressions were taken before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). The 3D anthropometric analyses of digitized dental casts were obtained through a specific software. Intragroup changes were applied paired t test and Wilcoxon test (UCLA group) and for the UCLP group, repeated-measures analyses of variance followed by the Tukey test. For intergroup analyses, an independent t test and Mann-Whitney test were used. The palatal dimensional changes of UCLA group showed that the distances IC, I-T', and I-T significantly increased after cheiloplasty (p = 0.0002, p = 0.0007 and p < 0.0001, respectively). In the UCLP group, the IC' distance statistically decreased in the post-surgical periods (p < 0.0001), while the I-T distance increased (p < 0.0001). The IC distance increased after cheiloplasty (p < 0.0001). The I-T' distance increased between T2 and T3 with statistically significant differences (p = 0.0037). The intergroup analysis of palatal development (T2-T1) showed that the distances IC' and I-T' demonstrated a reduction of the dental arches growth of UCLP group compared with the UCLA group, with statistically significant differences. The new 3D anthropometric analysis showed that the development of the maxillary segments changed after surgical repair. The UCLP group demonstrated a reduction of the dental arches growth compared with the UCLA group.
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Affiliation(s)
- Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Chiarella Sforza
- Human Anatomy, Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Faculty of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
| | - Márcio De Menezes
- School of Health Science, State University of Amazonas, Manaus, Brazil
| | - Cleide Felício Carvalho Carrara
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Maria Aparecida Andrade Moreira Machado
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.
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