Neelutpal Bora1, Madhurjya Chakraborty2
PRESENTATION OF CASE
Clefts of the lip and palate unfortunately are by far the most common major facial malformations in mankind. Fortunately, as a result of technical advancements in the fields of medicine and their families for treatment, much can be done and achieved for them.
The orthodontist by virtue of having gained in depth knowledge of the craniofacial complex, its growth and development and expertise in tooth movement has to play a role of prime importance in making critical decisions, planning treatment and rendering care to these patients.
Nasoalveolar Molding (NAM) is a tissue-expansion procedure performed by dentists prior to a surgical repair for cleft lip and palate.1 The NAM technique allows the paediatric dentist and surgeon to mold the abnormally-formed nasal cartilage into a more optimal relationship prior to surgery.2 The carefully-controlled tissue expansion created by the NAM allows for the creation of a more normal-appearing nose at the time of surgery for the lip closure than compared to traditional treatment by secondary alveolar bone grafting.
Creating a symmetrical nose from the deficient columella and deformed nasal cartilage in cleft patients is a great challenge. The lower lateral alar cartilage in patients with unilateral cleft lip and palate is depressed and concave in the alar rim. It separates from the non-cleft-side lateral alar cartilage resulting in depression and displacement of the nasal tip. The columella is shorter on the cleft side and is inclined over the cleft with the base deviated toward the non-cleft side.
Presurgical nasal molding also has been introduced as an adjunctive neonatal management for preoperative correction of nasal deformities by utilising the malleability of alar cartilage shortly after birth. Grayson et al proposed the combination of presurgical orthopaedics and nasal molding as a new technique called presurgical nasoalveolar molding for approximating the alveolar cleft and improving the nasal deformities preoperatively.