Presurgical Nasoalveolar Molding Modified Technique in Complete Bilateral Cleft Lip and Palate Infant: A Case Report

Abstract

Through this research, we have presented a modified presurgical nasoalveolar molding (PNAM) device, protocol, and equipment of preoperative nasal alveolar formation techniques to improve lip, nose, alveolar, and palatal deformity in the Department of Orthodontics and Maxillo-Facial Department at the University of Prishtina. A two-week-old boy was brought to our Department of Orthodontics. The baby was diagnosed with non-syndrome bilateral complete cleft of the primary and secondary palate. After a complete examination and orthodontic therapeutic planning, precaution was taken for creating a PNAM appliance and sent to the laboratory. An intraoral molding plate was established on both sides of the separate segments of the maxilla and fixed with a mini screw to approximate the maxillary segments. Parts of the strings built in the front side activated (please check) and, together with the nasal stent, were added to correct the nose deformity. By using modified NAM to close the cleft segments, both the ones of the upper lip and the ones of the palate, we achieved the same results and reduced possible tissue damage by maintaining the conventional NAM apparatus. We used an alveolar formation plate with traction stainless steel to reduce the separate parts. Under this presurgical treatment, the cleft alveolus and palatal segments were reduced considerably. Also, the parts of the flatting nasals of the nose were set up. Through interdisciplinary work, we created a new modified NAM appliance to avoid the obstacles of the traditional NAM devices and to improve the presurgical treatment by using the benefits of the postnatal period of the child to have a more effective treatment. Despite the inability of previous studies to decide on the degree of efficacy of PNAM and the fact that scientific data is limited, we consider that our research can contribute to a better understanding of why it is essential to use PNAM and of the need to enhance the apparatus.