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.