Nasoalveolar molding treatment in Presurgical infant orthopedics in cleft lip and cleft palate patients
Nasoalveolar molding is the nonsurgical, passive method of bringing the gum and lip together by redirecting the forces of natural growth. It is nonpainful and easy to use. It also allows for correction of the flattened nose prior to surgery and facilitates nose repair at the time of lip repair.
Protocol
Ist visit:
Parent education and counselling
- Use of audio visual aids and live demonstrations
- Interaction with parents of older NAM patients
- Diet counselling
Detailed documentation:
- Photographs- standard 1:1 ratio frontal and basilar view
- Dentofacial impressions
- Medical evaluation of patients
Fabrication of NAM appliance:
- > 8-10mm intersegment distance – alveolar molding
- < 8-10mm intersegment distance – nasoalveolar molding
Demonstration of home care instructions:
- Daily appliance care
- Awareness about possible complications and their management
Telephonic corresspondence after 2 days to ascertain parent and patient compliance
2nd visit (1 week subsequent to first visit):
Evaluation of patient and parent compliance.
Detailed documentation:
- Photographs- standard 1:1 ratio frontal and basilar view
- Dentofacial impressions
Treatment outcome and assessment:
- Compatibility of appliance and required modifications.
- < 8-10mm intersegment distance – initiate nasoalveolar molding
- > 8-10mm intersegment distance – aggressive alveolar molding
Recall visits every 3 weeks:
Evaluation of patient and parent compliance.
Detailed documentation:
- Photographs- standard 1:1 ratio frontal and basilar view
- Alveolar surface impressions
- Dentofacial impressions recorded prior to primary lip repair
Treatment outcome and assessment:
- Compatibility of appliance and required modifications.
- Nasal molding started at the earliest and continued till completion.
- Active alveolar molding continued till completion.
- Passive alveolar molding started once complete approximation of alveolar segment achieved.
- Fabrication of new appliance every 2 months.
- Parents participation in periodic NAM workshops
Post surgery nasal molding:
- Use of customised silicone nasal conformer for 6 months after primary lip repair.