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ObjectiveThis brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP).MethodsThirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups.ResultsIn PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p

Patients with different types of labio-maxillo-palatine clefts go through a lifelong series of multidisciplinary therapeutic procedures; this “journey” sometimes begins prenatally and extends into adulthood. Presurgical orthopedic treatment (PSO) is one of the first stages of this therapeutic plan. The nasoalveolar molding technique (NAM) is a new method of approach, from the field of pre-surgical orthopedics, instituted at a very young age (infant), and aims to reduce the initial severity, the level of alveolar cleft and/or the degree of nasal deformity. This approach enables the primary surgical restore of the nostril and lip to heal beneath minimum tension, thereby reducing scar formation and enhancing the esthetic result. The NAM technique is the non-surgical, passive method of bringing the gum and lip together by redirecting natural growth forces. NAM has been shown to be an effective adjunctive therapy for reducing pain, deformity and the level of soft tissue tearing before surgery. This paper reviews the basic principles of NAM therapy, the different types of devices used in this therapy, the protocol followed and a critical evaluation of the advantages and disadvantages of this technique. As an example, finally, we present the case of an infant with a unilateral labiomaxillary cleft, to which a NAM-type orthopedic device was applied with the aim of reducing tensions at the level of the tissues with the defect, to minimize the extent of the surgical intervention and to minimize the risk of postsurgical retractile scars. Worldwide, the authors of various studies agree on the positive outcome of NAM for better aesthetics after surgical repair of cleft lip and palate (DLP). However, what still remains, at this moment, unfounded equivocal is whether the pre-surgical reduction of the cleft sizes and the modeling manipulation of the nasal complex benefit our patients in the long term. Despite a relatively small amount of high-level evidence, NAM appears to be a promising technique that deserves further research. [ABSTRACT FROM AUTHOR]

A short columella and a flattened nasal tip are the characteristic stigmata of patients with complete bilateral cleft lip and palate (BCLP). Objective: The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM). Setting and Patients: A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults. Results: Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width. Conclusions: Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample. [ABSTRACT FROM AUTHOR]

Cleft lip and palate are common congenital deformities that significantly impact facial anatomy and function, often requiring surgical intervention to correct. Presurgical nasoalveolar molding (NAM) therapy has emerged as an effective nonsurgical approach to improve surgical outcomes by reducing the severity of clefts and molding the alveolar, lip, and nasal segments into more favorable positions. This case report describes the use of NAM therapy in a 15-day-old patient with unilateral cleft lip, palate, and nasal involvement to improve outcomes before cheiloplasty. The patient presented with significant feeding difficulties due to a large palatal cleft. After obtaining parental consent, we conducted a series of procedures to construct and insert an acrylic NAM plate with a retention button and nasal stent, performing weekly adjustments to reshape the alveolar segments and nasal cartilage. Weekly remodeling included selective modifications to the NAM plate, the addition of soft liners, and the use of nasal stents to lift the collapsed nasal cartilages and restore nasal symmetry. Post-treatment results showed a substantial reduction in the cleft lip gap from 17 mm to 6 mm, alveolus gap from 14 mm to 4 mm, left nasal width from 17 mm to 11 mm, and increased left alar height from 4 mm to 7 mm. The successful application of NAM therapy demonstrated its effectiveness in reducing cleft gaps, improving nasal anatomy, and preparing the patient for future surgical interventions with minimal scar formation. This case reinforces the benefits of NAM in reducing cleft deformities, improving feeding function, and avoiding more invasive surgical procedures., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. issued approval not applicable. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Objective: Nasoalveolar molding (NAM) is an accepted presurgical treatment modality for newborns with cleft lip and palate (CLP). However, the therapy is time-consuming and requires high expertise. To facilitate the treatment, we reveal an algorithm for the automated generation of patient individual NAM devices for neonates with bilateral cleft lip and palate (BCLP) and present results of software validation. Methods: The algorithm was implemented utilizing Python 2.7 and Blender 2.78a based on 17 digitized (3D-scanning) impressions of maxillae with BCLP. The algorithm segments alveolar structures, bridges clefts, and generates a series of NAM device designs, destined for 3D-printing for subsequent treatment. The datasets were used for first software tests. For validation, a follow-up study was carried out using six new, independent maxilla models. The generated NAM plate designs were examined regarding their potential clinical usability. Furthermore, a deviation analysis was carried out, which measured the plate models’ and upper jaw models’ surface deviations. Results: Series of NAM devices were generated automatically in 21 out of 23 cases. We calculated an average surface deviation of 0.140 mm (SD: 0.016 mm). Four out of six plate series (follow-up trials) were assessed as probably usable with minor adjustments. Conclusion: The algorithm generates 3D-printable series of NAM device designs reliably. We expect most of the series to be clinically usable and that the first plates of each series will fit the patients’ maxillae. Significance: The proposed algorithm has the potential to reduce the therapist's manual work and therefore time effort/costs related to NAM. [ABSTRACT FROM AUTHOR]

Aim This study aimed to determine and compare the cytotoxicity of light-cured composite resin (Enlight light cure composite (Ormco, Glendora, California, USA)), light-cured acrylic resin (Orthocryl LC (Dentaurum, Ispringen, Germany)), and the self-cure acrylic (DPI RR cold cure acrylic (Dental Products of India, Bombay Burmah Trading Corporation Ltd., Mumbai, India)) material and to determine which component is best to be used for the purpose of nasal stent fabrication in the nasoalveolar molding (NAM) technique for cleft therapy. Methods Circular discs made from Enlight light cure composite, Orthocryl LC, and self-cure acrylic were submerged for 24 hours in gingival fibroblast media (three discs of each material) and control medium (three discs of each material) that were both contained in plates. After analyzing the optical densities of the plates, the cytotoxicity of the products was assessed by measuring cell viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The compiled data was analyzed using IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY). The normality of the data was evaluated using the Shapiro-Wilk test. One-way analysis of variance (ANOVA) and pairwise comparison made with Tukey's honestly significant difference (HSD) post hoc test with a significance level (p) of 0.05 were considered. Results The percentage of cell viability was between 80% and 150%. A significant mean difference was noted in the cell viability between the three groups (p=0.009). High mean cell viability was seen in Orthocryl LC. However, there was no significant mean difference between Orthocryl LC and Enlight light cure composite material (p=0.854). Conclusion Both Orthocryl LC and Enlight light cure composite materials are less cytotoxic when compared to the self-cure acrylic resin material and can be used to fabricate the nasal stent component for infants with cleft defects, undergoing NAM procedure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bhatia et al.)

Objective: To assess weight gain of infants with cleft lip and/or palate (CL ± P) treated with nasoalveolar molding (NAM). Design: Retrospective, case–control chart review. Setting: Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. Patients, Participants: Infants with nonsyndromic CL ± P and noncleft controls. Interventions: Prior to primary lip surgery, NAM was either included (+NAM) or not included (−NAM) in the cleft treatment protocol. Main Outcome Measure(s): Weight gain and percentage weight gain relative to initial weight were compared among +NAM, −NAM, and control groups from birth to 7 months and from birth to 36 months. Results: Comparing +NAM and −NAM groups, no significant difference in weight or percentage weight gain was found in either time window. Compared to controls, from birth to 7 months, both CL ± P groups weighed less (P <.001), while percentage weight gain was greater for the +NAM (P <.001) and did not differ for −NAM. From birth to 36 months relative to controls, weight for +NAM showed no significant difference and −NAM weighed less (P <.01), while percentage weight gain was greater for both CL ± P groups (P <.001). Conclusions: Comparisons of CL ± P infants treated with and without NAM showed that with the NAM appliance, despite its added complexity, there was no adverse impact on weight gain. Comparisons to noncleft, control infants suggests that NAM treatment may have a beneficial impact on weight gain. [ABSTRACT FROM AUTHOR]

Objective: Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip. Design: The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM). Setting and Patients: 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents. Results: Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample. Conclusions: NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage. [ABSTRACT FROM AUTHOR]

Introduction: The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced., Aims: This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to a control group where no NAM was used., Material and Methods: At a tertiary care paediatric hospital, a historical cohort group of complete BCLP patients (n=15) was compared to a prospectively collected group of complete BCLP patients who underwent NAM therapy (n=15). In the NAM group (mean age: 1.1mos±0.2), a new modification of the NAM appliance was implemented. In the control group (mean age: 5mos±0.2), no NAM treatment was adopted prior to lip closure surgery. Soft tissue nasolabial segments were measured on initial (T1), post-NAM (T2) and 3 months post-surgery (T3) photographs; measurements were analysed statistically., Results: In the NAM group, cleft size was reduced by 68 to 70% in 4-5months and all measurements improved between T1 and T2. Columellar crest inclination decreased by 74%, columellar length increased by 184%, nostril and bialar widths decreased by 36% and 16%, respectively. The lip philtrum was elongated by 49.5%. At T3, all soft tissue variables statistically improved better in NAM versus non-NAM groups., Conclusion: The modified NAM appliance provided improved results of lip approximation and nasal measurements compared to non-NAM treatment., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objective: This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP)., Methods: Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups., Results: In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant ( p  < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm., Conclusion: Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Yin, Zhang, Huang, Shi, Zheng and Yang.)

Objective: The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM)., Setting and Patients: A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults., Results: Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width., Conclusions: Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample.

Objective: To assess weight gain of infants with cleft lip and/or palate (CL ± P) treated with nasoalveolar molding (NAM)., Design: Retrospective, case-control chart review., Setting: Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon., Patients, Participants: Infants with nonsyndromic CL ± P and noncleft controls., Interventions: Prior to primary lip surgery, NAM was either included (+NAM) or not included (-NAM) in the cleft treatment protocol., Main Outcome Measure(s): Weight gain and percentage weight gain relative to initial weight were compared among +NAM, -NAM, and control groups from birth to 7 months and from birth to 36 months., Results: Comparing +NAM and -NAM groups, no significant difference in weight or percentage weight gain was found in either time window. Compared to controls, from birth to 7 months, both CL ± P groups weighed less ( P < .001), while percentage weight gain was greater for the +NAM ( P < .001) and did not differ for -NAM. From birth to 36 months relative to controls, weight for +NAM showed no significant difference and -NAM weighed less ( P < .01), while percentage weight gain was greater for both CL ± P groups ( P < .001)., Conclusions: Comparisons of CL ± P infants treated with and without NAM showed that with the NAM appliance, despite its added complexity, there was no adverse impact on weight gain. Comparisons to noncleft, control infants suggests that NAM treatment may have a beneficial impact on weight gain.

Objective: Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip., Design: The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM)., Setting and Patients: 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents., Results: Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample., Conclusions: NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.