Presurgical infant orthopedics

Case Description: Cleft lip and palate is one of the common facial deformities. Alveolar and nasal reconstruction is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding was introduced to mold the maxillary, alveolar, and nasal tissues prior to first surgical repair. Nasoalveolar molding also stimulated immature nasal chondroblasts, producing an interstitial expansion, which can improve nasal morphology.This appliance allowed the alignment of the intraoral alveolar segments and correction of the nasal tip, columella, the alar base and the philtrum. This paper aims to describe the treatment of two newly born male infants where presurgical orthopedic therapy was used. Two newly born male babies with a left cleft lip and palate. At two days of birth the impression for nasoalveolar molding was made. On the 15th day, we started alveolar modeling for six weeks. Nasal modeling was made for the next six weeks. The baby was seen weekly to make adjustments to the molding plate. The nasoalveolar molding aplliance was secure extraorally to the cheeks bilaterally by surgical tapes with orthodontic elastic bands at one end. Discussion: The tissue molding we achieved was measured on the lip approximation and was reduced from 3cm to 0,9cm on one subject and 3cm to 1,2cm on the other one. Conclusion: Presurgical orthopedic therapy of the cleft infant is intended to reduce severity of the oronasal deformity prior to surgery. Molding the nasal cartilage, premaxilla and alveolar ridges in the neonatal period with surgical procedures results in better aesthetics and a reliable longterm result. Keywords: Orthodontics, nasoalveolar molding, cleft lip and palate, NAM appliances, NAM protocol, presurgical infant orthopedics