Presurgical Cleft Lip Management: Nasal Alveolar Molding

Travis T. Tollefson; Richard R. Gere

doi:10.1055/s-2007-979280

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2007; 23(2): 113-122
DOI: 10.1055/s-2007-979280

Presurgical Cleft Lip Management: Nasal Alveolar Molding

Travis T. Tollefson¹ , Richard R. Gere¹

¹Cleft and Craniofacial Program, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California

Abstract

ABSTRACT

Continued advancement in the comprehensive care of children with cleft lip and palate has resulted in numerous innovative treatment protocols. The cooperation of numerous specialties has continued to expand the options for difficult cases. A high standard for aesthetic and functional results has been established. Presurgical treatment of a cleft alveolus and its associated soft tissues with presurgical orthopedics is just one of these techniques. Differing opinions of the effectiveness, growth disturbances, and additional costs of presurgical molding are often debated, but the concepts should be understood by any cleft surgeon or orthodontist involved in cleft care.

KEYWORDS

Nasal alveolar molding - presurgical orthodontics - cleft lip and palate - PNAM

Full Text

References

REFERENCES

1 McNeil C. Orthodontic procedures in the treatment of congenital cleft palate. Dent Rec. 1950; 72 126-132
2 Grayson B, Cutting C. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J. 2001; 35 193-198
3 Georgiade N, Latham R. Maxillary arch alignment in bilateral cleft lip and palate infant, using the pinned coaxial screw appliance. Plast Reconstr Surg. 1975; 56 52-60
4 Georgiade N, Mladick R, Thorne F. Positioning of the premaxilla in bilateral cleft lips by oral pinning and traction. Plast Reconstr Surg. 1968; 41 240-243
5 Millard D, Latham R. Improved primary surgical and dental treatment of clefts. Plast Reconstr Surg. 1990; 86 856-871
6 Latham R. Orthodontic advancement of the cleft maxillary segment: a preliminary report. Cleft Palate J. 1980; 17 227-233
7 Matsuo K, Hirose T, Tomono T et al.. Nonsurgical correction of congenital auricular deformities in early neonate: a preliminary report. Plast Reconstr Surg. 1984; 73 38-50
8 Singh G, Moxham B, Langley M et al.. Changes in the composition of glycosaminoglycans during normal palatogenesis in the rat. Arch Oral Biol. 1994; 39 401-407
9 Matsuo K, Hirose T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg. 1991; 44 5-11
10 Grayson B, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg. 1993; 92 1422-1423
11 Cutting C, Grayson B, Brecht L et al.. Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair. Plast Reconstr Surg. 1998; 10 630-639
12 Maull D, Grayson B, Cutting C et al.. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J. 1999; 36 391-397
13 Grayson B, Santiago P, Brecht L et al.. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999; 36 486-498
14 Tollefson T, Senders C, Sykes J et al.. Botulinum toxin to improve results in cleft lip repair. Arch Facial Plast Surg. 2006; 8 221-222
15 Spengler A, Chavarria C, Teichgraeber J et al.. Presurgical nasoalveolar molding therapy for the treatment of bilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2006; 43 321-328
16 Boyne P. Use of marrow cancellous bone grafts in maxillary alveolar and palatal clefts. J Dent Res. 1974; 43 821-824
17 Boyne P, Sands N. Secondary bone grafting of residual alveolar and palate clefts. J Oral Surg. 1972; 30 87-92
18 Long R, Spangler B, Yow M. Cleft width and secondary alveolar bone graft success. Cleft Palate Craniofac J. 1995; 32 420-427
19 Salyer K, Genecov E, Genecov D. Unilateral cleft lip-nose repair: a 33 year experience. J Craniofac Surg. 2003; 14 549-558
20 Skoog T. The use of periosteum and Surgicel for bone restoration in congenital clefts of the maxilla. Scand J Plast Reconstr Surg. 1967; 1 113-130
21 Pfeifer T, Grayson B, Cutting C. Nasoalveolar molding and gingivoperiosteoplasty versus alveolar bone graft: an outcome analysis of costs in the treatment of unilateral cleft alveolus. Cleft Palate Craniofac J. 2002; 39 26-29
22 Ross R. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 7: an overview of treatment and facial growth. Cleft Palate J. 1987; 24 71-77
23 Wood R, Grayson B, Cutting C. Gingivoperiosteoplasty and midfacial growth. Cleft Palate Craniofac J. 1997; 34 17-20
24 Chin M, Ng T, Tom W et al.. Repair of alveolar clefts with recombinant human bone morphogenetic protein (rhBMP-2) in patients with clefts. J Craniofac Surg. 2005; 16 778-789
25 McComb H. Primary correction on unilateral cleft lip nasal deformity: a 10-year review. Plast Reconstr Surg. 1985; 75 791-797
26 Trott J, Mohan N. Preliminary report on one-stage open-tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate: the Alor Setar experience. Br J Plast Surg. 1993; 46 215-222
27 Mulliken J. Correction of the bilateral cleft lip nasal deformity: evolution of a surgical concept. Cleft Palate Craniofac J. 1992; 29 540-545
28 Millard D R. Bilateral cleft lip and a primary forked flap: a preliminary report. Plast Reconstr Surg. 1967; 39 59-65
29 Bennum R, Perandones C, Sepliasrsky V et al.. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: a 6-year follow-up. Plast Reconstr Surg. 1999; 104 616-630
30 McComb H, Coghlan B. Primary repair of unilateral cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac J. 1996; 33 12-31
31 Pai B, Ko E, Huang C et al.. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2005; 42 658-663
32 Liou E, Subramanian M, Chen P et al.. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg. 2004; 114 858-864
33 Singh G, Levy-Bercowski D, Santiago P. Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: geometric morphometrics. Cleft Palate Craniofac J. 2005; 42 403-409
34 Yuzuriha S, Matsuo K, Kondoh S. A newly designed nasal retainer to sustain the corrected shape of the nostril rim and anterior nasal recess for cleft lip patients. Plast Reconstr Surg. 2001; 108 452-455
35 Nakajima T, Yoshimura Y, Sakakibara A. Augmentation of the nostril splint for retaining the corrected contour of the cleft lip nose. Plast Reconstr Surg. 1990; 85 182-186
36 Hotz M M, Gnoinski W M. Comprehensive care of cleft lip and palate children at Zurich University: a primary report. Am J Orthod. 1976; 70 481-504

Travis T TollefsonM.D. F.A.C.S.

Assistant Professor, Cleft and Craniofacial Program, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California

Davis Medical Center 2521 Stockton Blvd., Suite 7200, Sacramento, CA 95817