Role of presurgical nasoalveolar molding in the repair of unilateral cleft lip
Subhrangshu Dutta1, Kartik Chandra Mandal2, Saheli Majumder3, Sourav Roy4, L Neilasano5, Pankaj Kumar Halder4
1 Department of Pediatric Orthodontic Surgery, Dr. B.C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
2 Department of Pediatric Surgery, Dr. B.C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
3 Department of Orthodontia, Mayapur Community Hospital, Mayapur, West Bengal, India
4 Department of Pediatric Surgery, R. G. Kar Medical College, Kolkata, West Bengal, India
5 Department of General Surgery, R. G. Kar Medical College, Kolkata, West Bengal, India
Dr. Pankaj Kumar Halder
Saroda Pally, Baruipur, Kolkata - 700 144, West Bengal
Source of Support: None, Conflict of Interest: None
Aim: A study aims to reappraise the merits of nasoalveolar molding before the repair of unilateral cleft lip.
Materials and Methods: A prospective study was conducted with 20 cases of the unilateral complete cleft lip for 3 years. We counseled the parents, offered them to choose the surgical procedure with/without preoperative nasoalveolar molding (NAM), and obtained consent from them. The nasolabial closure was done either after aligning the cleft segments with NAM or without preoperative NAM. The patients were followed up for 1 year and assessed. Both groups are then compared with normal healthy individuals of the same age group.
Results: Depending on preoperative NAM, the patients were divided into Groups A (without NAM) and B (with NAM). All the facial proportions and angles (except oral commissural width: facial width and nasal tip angle) of Group B are much closer to the values of normal age-controlled individuals. However, a significant difference existed between the Group A values and normal individuals. Group B showed better nasal symmetry and restoration of normal proportions. The quality of scar produced was significantly superior in Group B when compared to Group A. Body weight change was also significantly different in the two groups. Group B seemed to catch the 15th percentile while Group A stayed at the 3rd percentile in the postoperative period.
Conclusion: Presurgical NAM helps to restore the normal facial proportions and produces a healthier scar. Furthermore, the bodyweight of patients seems to improve as the NAM plate acts as a feeding plate.