Early functional restoration in cleft patients by presurgical infantile orthopedics with follow up
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20242651Keywords:
Presurgical nasoalveolar molding, Cleft lip, Presurgical infantile orthopedicsAbstract
Cleft lip and palate present significant surgical challenges, particularly in cases of extensive clefts associated with severe nasolabial deformities. This case series focuses on the role of presurgical naso alveolar molding (PNAM) in improving surgical outcomes by reducing cleft deformities and enhancing facial symmetry. PNAM, combined with nasal stenting and presurgical orthopedics, aids in aligning the segments of the alveolar cleft and correcting nasal cartilage asymmetry. The study involved bilateral and unilateral cleft repairs, utilizing the Randall's modification of tennison triangular flap for unilateral cases and the Millard-Mulliken procedure for bilateral full clefts. Precise preoperative marking, meticulous tissue rearrangement, and multi-layer closure were key to achieving optimal results. Postoperative care included close monitoring, with skin sutures removed on the fifth day. The results align with existing literature, demonstrating the effectiveness of PNAM in narrowing the cleft and achieving nasal symmetry. This case series highlights the importance of early intervention and the application of PNAM plates in the comprehensive treatment of cleft lip and palate, contributing to favorable outcomes in reconstructive surgery.
References
Grayson BH, Cutting CB. Presurgical nasoalveolar orthopaedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J. 2001;38:193-8.
Patel D, Goyal R, Puri T. Presurgical nasoalveolar moulding – An adjunct to facilitate surgical repair in infants with cleft lip and palate. Mod Plast Surg. 2013;3:34-42.
Dolly Patel, Ramesh Goyal. Pre-surgical nasoalveolar moulding in patient with unilateral cleft of lip, alveolus and palate: Case report. Journal of plastic, reconstructive& aesthetic surgery 2012;65:122-6.
Barillas I, Dec W, Warren SM. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip and cleft palate patients. Plast Reconstr Surg. 2009;123:1002-6.
Lee CT, Garfinkle JS, Warren SM. Nasoalveolar molding improves appearance of children with bilateral cleft lip and cleft palate. Plast Reconstr Surg. 2008;122:1131-7.
Randall P. A triangular flap operation for the primary repair of unilateral clefts of the lip. Plast Reconstr Surg Transplant Bull. 1959;23(4):331-47.
Mulliken JB, Wu JK, Padwa BL. Repair of bilateral cleft lip: review, revisions, and reflections. J Craniofac Surg. 2003;(5):609-20.
Pai BC, KO EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2005;42:658-63.
Grayson BH, Shetye PR. Presurgical nasoalveolar moulding treatment in cleft lip and palate patients. Indian J Plast Surg. 2009;42:56-61.
Liao YF, Mars M. Hard palate repair timing and facial growth in cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2006;43(5):563-70.
