BACKGROUND: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding.
METHODS: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software.
RESULTS: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05).
CONCLUSIONS: Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

BACKGROUND: 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.
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.

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.

Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution\'s ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children\'s Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.

UNASSIGNED: The present clinical report describes management of complete unilateral cleft lip and palate with presurgical nasoalveolar molding (NAM) therapy for infants.
UNASSIGNED: Orofacial clefts have a negative impact on the health and social integration of individuals affected. Patients undergo numerous procedures until they reach adolescence. The ultimate focus of surgical intervention is to improve the esthetic appearance of the lip and nose by improving the lip scar, nasal tip projection, and symmetry of the nasolabial complex.
UNASSIGNED: This paper discusses a situation in which the parents of a three days old baby with the chief complaint of regurgitation of milk while feeding. On examination, baby had complete left-sided cleft lip and cleft palate (CL+CP).
UNASSIGNED: Before surgery, nasoalveolar molding has been shown to be a useful adjunctive therapy for reducing hard and soft tissue cleft deformity.
UNASSIGNED: Passive preoperative intervention of the lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcomes by minimizing wound healing disturbances and scarring.
UNASSIGNED: Shaik N, Eggula A, Pudi S, et al. Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report. Int J Clin Pediatr Dent 2023;16(4):659-662.

OBJECTIVE: Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared.
METHODS: We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured.
RESULTS: Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle.
CONCLUSIONS: NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth.
CONCLUSIONS: The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.

The frequency of cleft lip and palate births in Japan is approximately 0.146%. The study aimed to compare the effects of NAM on restoring nasal morphology and improving extraoral nasal morphology in children with cleft lip and palate in the first stage of treatment using 3D imaging and oral model analysis. The subjects were five infants (37.6 ± 14.4 days old) with unilateral cleft lip and palate. The images taken with the 3D analyzer and oral model used for constructing the NAM at the first examination (baseline) and at the completion of the pre-surgical orthodontic treatment (157.8 ± 37.8 days old) were analyzed. The cleft distance was measured at the upper, middle, and lower points on the 3D images. On the model, the cleft jaw width at the maximum protrusion of the healthy and affected sides of the alveolar bone was measured. After the pre-surgical orthopedic treatment, the measured value on the model decreased significantly by a mean of 8.3 mm from baseline, and the cleft lip width narrowed by an average of 2.8 ± 2.2, 4.3 ± 2.3, and 3.0 ± 2.8 mm at the upper, middle, and lower points of the cleft, respectively. Pre-surgical orthopedic treatment using NAM can help narrow the width of the cleft jaw and lip. The sample size is stated at the study limit in the paper.

UNASSIGNED: To highlight the effectiveness of Presurgical Nasoalveolar Molding (PNAM) technique and the appliance used prior to the surgical reconstruction of cleft lip and palate in newborns.
UNASSIGNED: In underdeveloped and developing countries, babies born with oral clefts, are generally anemic with low birth weight and may be unfit for surgery immediately. Feeding these babies is also difficult as the air leaks through the cleft and they cannot create the suction needed for suckling.
UNASSIGNED: Two newborn babies, presented with unilateral midfacial clefts involving the lip, alveolus and palate.
UNASSIGNED: The PNAM appliance enabled breast Feeding while lessening the soft tissue and cartilaginous deformity and allowing surgical soft tissue repair with minor scar formations.
UNASSIGNED: PNAM can reduce the surgical burden and reduce the number of surgical revisions when initiated early.
UNASSIGNED: Ferreira AN, Eswaramurthy P, Aras MA, et al. Rehabilitation of an Orofacial Cleft through Presurgical Nasoalveolar Molding with a 1-year follow-up. Int J Clin Pediatr Dent 2023;16(1):162-165.

UNASSIGNED: The aim of this case report is to highlight the importance of presurgical nasoalveolar molding (PNAM) in cleft lip and palate (CLP) cases and its impact on primary surgical outcomes.
UNASSIGNED: Cleft lip and palate (CLP) is one of the most common congenital malformations of the maxillofacial complex. Of all congenital malformations, it ranks third and has a multifactorial etiology. Such anomalies can have several consequences, such as impaired suckling, defective speech, deafness, malocclusion, gross facial deformity, and bring tremendous stress on the entire family. Surgical correction is required to restore the form and function of the affected area; however, surgery has to be usually deferred due to the age of the newborn patients.
UNASSIGNED: A 12-day-old neonate born with a bilateral cleft of lip and alveolus was referred from the Department of Plastic Surgery. PNAM was planned in consultation with the plastic surgeon. A customized nasoalveolar molding plate was fabricated, and tissue molding was carried out. Following nasoalveolar molding, primary surgical repair was done.
UNASSIGNED: Significant reduction in cleft width, approximation of soft tissue of the lip, and improvement in nasal tip alignment were achieved following PNAM. It favorably positioned the tissue segment and minimized the extent of the local tissue dissection and advancement. The synchronous prosthodontics and surgical treatment resulted in optimal treatment outcomes.
UNASSIGNED: The higher level of estrogen and hyaluronic acid in the newborn that remodels the cartilage can be utilized through the light application of forces, and hence hard and soft tissue molding can be achieved without surgery. PNAM acts as a promising adjunct prior to primary surgical closure of the CLP. Thus, PNAM immediately after the birth can serve to significantly augment the surgical outcomes and the extent and/or the number of surgeries can be reduced.
UNASSIGNED: Rathee M, Singh K, Alam M, et al. Surgical Assistance for Favorable Outcome Achieved through Presurgical Nasoalveolar Molding Using Innovative Impression Technique: A Case Report. Int J Clin Pediatr Dent 2023;16(1):153-158.

UNASSIGNED: A significant improvement in the nasal symmetry after presurgical nasoalveolar molding (PNAM) is seen in complete unilateral cleft lip and palate (UCLP) infants. However, the follow-up changes in the nasal symmetry before and after PNAM and surgical repair have not been well documented.
UNASSIGNED: The purpose of this retrospective study is to assess the progressive changes in the nasal symmetry after PNAM and primary cheiloplasty to 1 year in complete UCLP infants. Out of 28 complete UCLP patients who were given PNAM treatment during the period between January 2014 to March 2019, 19 UCLP infants could be included for the study. Submental oblique photographs at the initial visit (T1), immediately after cheiloplasty (T2), and 1 year (T3) after cheiloplasty were selected, and quantity of nasal asymmetry at each period (T1-T2; T1-T3; and T2-T3) was analyzed by paired t-test (P < 0.05).
UNASSIGNED: The quantity of asymmetry revealed that there was a highly significant improvement (P < 0.001) in nasal asymmetry at T1-T2 and T1-T3. Nonsignificant relapse was observed at T2-T3; however, a significant relapse in nasal dome height was observed during this period.
UNASSIGNED: The improvement in the nasal symmetry after cheiloplasty in PNAM-treated patients is maintained till 1 year postsurgically though there is a nonsignificant relapse.