OBJECTIVE: Development and evaluation of a mobile application for remote monitoring and guidance of pediatric patients diagnosed with cleft lip and/or palate (CL ± P) and their caregivers.
METHODS: This is a pilot cross-sectional, applied, and quantitative study.
METHODS: The study was conducted in two tertiary care treatment centers in Brazil.
METHODS: The participants included 20 caregivers and infants undergoing treatment with nasoalveolar molding (NAM) for CL ± P.
METHODS: The intervention involved using the TeleCleft mobile application for remote monitoring and guidance of caregivers and infants during NAM treatment.
METHODS: The main outcome measures included usability and satisfaction of users with the TeleCleft application.
RESULTS: The results showed high usability and satisfaction ratings among users of the TeleCleft application. Most participants found remote monitoring to be effective and expressed positive opinions about its convenience and usefulness.
CONCLUSIONS: TeleCleft could be a viable tool for remote monitoring and guidance, reducing the need for patients and caregivers to travel to treatment centers, which could potentially alleviate the burden of care faced by families during the journey of CL ± P treatment.

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.

OBJECTIVE: Presurgical Nasoalveolar molding (PNAM) is a technique used for cleft lip and palate patients prior to cheiloplasty. However, concerns exist regarding its negative impact on maxillary arch growth.This study aimed to assess the effect of selective trimming in NAM on maxillary arch growth in patients with unilateral cleft lip palate.
METHODS: The retrospective observational study analyzed the study casts of 30 patients before and after undergoing nasoalveolar molding treatment. Study casts which were repositories of the institute were analyzed and segregated as Group A: NAM given with selective trimming of the appliance, and Group B: NAM without selective trimming of the appliance. Pre and post-treatment casts were assessed digitally at L-L\' (Intercleft segment width), C-C\' (Intercanine width), T-T\' (Alveolar arch width), L-TT\' (Alveolar arch length from major cleft segment), and L\'-TT\' (Alveolar arch length from minor cleft segment) RESULTS: A notable significant difference between Group A\'s and B\'s mean Alveolar arch width and Intercleft segment width was seen. Whereas parameters such as intercanine width, and alveolar arch length as functions from major and minor segments showed no significant variance.
CONCLUSIONS: Although NAM has been known to affect the growth of the maxillary arch, this study proposes that techniques such as selective trimming can help counteract this drawback.

OBJECTIVE: This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP).
METHODS: Retrospective university hospital single center study.
METHODS: Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded.
METHODS: Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher\'s exact tests were utilized for statistical analysis.
METHODS: The need for ABG.
RESULTS: Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG.
CONCLUSIONS: GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.

OBJECTIVE: To three-dimensionally assess differences in craniomaxillofacial skeletal development in patients with operated unilateral cleft lip and palate (UCLP) treated with/without presurgical nasoalveolar molding (PNAM) with a mean age of 5 years.
METHODS: Cone-beam CT radiographs of 30 patients with UCLP who had undergone PNAM and 34 patients with UCLP who did not receive PNAM were analyzed. The data were stored in DICOM file format and were imported into the Dolphin Imaging program for 3D image reconstruction and landmark identification. 33 landmarks, 17 linear and three angular variables representing craniofacial morphology were analyzed and compared by using the Mann-Whitney U tests.
RESULTS: The vast majority of linear variables and 3D coordinates of landmark points reflecting craniofacial skeletal symmetry were not significantly different between the two groups. In terms of craniofacial skeletal development, the PNAM group had a significantly smaller anterior nasal spine offset in the midsagittal plane and a greater maxillary length compared to the non-PNAM group.
CONCLUSIONS: Evaluations performed in early childhood showed that treatment with/without PNAM in the neonatal period was not a major factor influencing craniomaxillofacial hard tissue development in patients with UCLP; moreover, PNAM treatment showed significant correction of skeletal deviation at the base of the nose.
CONCLUSIONS: Follow-up in early childhood has shown that PNAM treatment administered during the neonatal stage does not impede maxillary development and has benefits in correcting nasal floor deviation. It is a viable option for improving nasal deformity in children with unilateral cleft lip and palate.

OBJECTIVE: To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate.
METHODS: An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach.
METHODS: Nasolabial Aesthetics, Dentoalveolar Relationship.
RESULTS: A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low.
CONCLUSIONS: When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.

OBJECTIVE: Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan.
METHODS: Randomised clinical trial.
METHODS: Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each).
METHODS: Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2).
METHODS: Changes in facial and nasolabial morphology.
RESULTS: Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle.
CONCLUSIONS: Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

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.

OBJECTIVE: This study aims to provide a comprehensive review and case study about the advantages and disadvantages of the application of digital technologies in presurgical orthopedics in newborns/infants with cleft lip and palate (CLCP). Positive changes in the nasal anatomy, maxillary arch, and cleft width could be achieved.
METHODS: Three representative cases of newborns/infants with CLCP were managed using the presurgical newborn/infant orthopedics (PSIO) approach. The patients were diagnosed and treated. Detailed descriptions of the impression procedures and PSIO appliance construction and placement were provided for each case.
RESULTS: Case 1 utilized traditional impression techniques, Case 2 employed a semi-digitalized approach with intraoral digital scanning, and Case 3 utilized a completely digitalized method for appliance construction. Positive changes in maxillary arch dimensions and cleft width reduction were observed in all cases.
CONCLUSIONS: The management of CLCP in newborns and infants poses a complex challenge with profound implications. The PSIO approach not only facilitates reconstructive surgery but also enhances overall quality of life. Digital tools, like specialized optical scanners and 3D printing, revolutionize the PSIO process, making it more efficient and patient-friendly. Clinical benefits include improved facial morphology, esthetics, feeding, speech, and optimized future surgical results. Despite ongoing efficacy debates, global adoption as the initial surgical approach underscores its value. The integration of digital technologies offers new hope for patients and families, promising a brighter future for those affected by this congenital condition.

OBJECTIVE: Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers\' perspectives and experiences with contemporary PSIO treatment.
METHODS: PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).
RESULTS: Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.
CONCLUSIONS: Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.