Evaluation of Maxillary Arch Dimensions and Arch Symmetry in Unilateral Cleft Lip and Palate Infants Treated with Nasoalveolar Molding

Abstract

Aim: The aim of this retrospective study was to evaluate the changes in maxillary arch parameters and symmetry after nasoalveoler molding in unilateral total cleft lip and palate infants. Material and Method: For this purpose, 5 female and 10 male infants 5-75 days previously treated with nasoalveoler molding were included. Strip bands were used in all cases together with the molding appliances. Infants were checked weekly until cleft segments were closed completely. Pretreatment and post molding photographs and casts were obtained. Amount of cleft, transversal distance of cleft, anterior and posterior arch widths, anterior and total arch lengths and asymmetry index were calculated on the study models. Paired t test was used to investigate whether there are any differences statistically between the pretreatment and posttreatment mean values, while Wilcoxon sign test was used in terms of differences between the median values. Results: Cleft widths decreased and cleft segments were closed each together after nasoalveoler molding in all cases. Anterior arch width did not show any significant change while posterior arch width increased statistically significant 2 mm . Anterior arch length decreased with a mean of 1,8 mm, while total arch length did not show any changes. The change of asymmetry index was found statistically significant. Conclusion: Cleft segments were aligned properly after nasoalveoler molding therapy and an improvement was obtained in arch symmetry

Keywords

• Unilateral cleft lip and palate, infant orthopedics, nasoalveolar molding

Nasoalveolar molding uygulanan unilateral dudak damak yarıklı bebeklerde ark boyutlarının ve ark asimetrisinin değerlendirilmesi

Abstract

Amaç: Bu retrospektif çalışmanın amacı unilateral total dudak damak yarıklı bebeklerde nazoalveoler molding sonrası maksiller ark parametrelerindeki ve simetrideki değişiklikleri incelemektir. Materyal ve Metod: Bu amaçla çalışmaya daha önce nazoalveoler molding tedavisi görmüş; 5 kız, 10 erkek bebek 5-75 günlük dahil edilmiştir. Tüm bebeklere nazoalveoler molding apareyi ve strip bantlar uygulanmıştır. Yarık segmentler birleşinceye kadar bebekler her hafta kontrol edilmiştir. Başlangıç ve nazoalveoler molding sonrası model ve fotoğrafları elde edilmiştir. Modeller üzerinde, başlangıç ve molding sonrası yarık ve transversal yarık uzaklığı miktarları, anterior ve posterior bölge ark genişlikleri, anterior ve total ark uzunlukları ve asimetri indeksi hesaplanmıştır. Başlangıç ve bitiş ortalama değerleri arasında istatistiksel olarak anlamlı fark olup olmadığı Bağımlı t testiyle araştırılırken, ortanca değerler yönünden farkın önemliliği Wilcoxon işaret testiyle incelenmiştir. Bulgular: Yarık hattı tüm vakalarda küçültülmüş ve segmentler birbirine tamamen yaklaştırılmıştır. Anterior bölge ark genişliği önemli bir değişiklik göstermezken, posterior bölge ark genişliği istatistiksel olarak önemli ölçüde artış göstermiştir 2 mm . Anterior ark

Keywords

• Unilateral dudak damak yarığı, infant ortopedisi, nazoalveolar molding

References

1. Stainer P, Moore GE. Genetics of cleft lip and palate: syndromic genes contribute to the incidence of non-syndromic clefts. Hum Mol Genet 2004; 1:73-81.
2. Calzolari E, Bianchi F, Rubini M, Ritvanen A, Neville AJ; EUROCAT Working Group. Epidemiology of cleft palate in Europe: implications for genetic research. Cleft Palate Craniofac J. 2004;41(3):244-249.
3. Vanderas AP. Incidence of cleft lip, cleft palate and cleft laip and palate among races: a review. Cleft Palate J 1987; 24: 216- 225.
4. Tunçbilek E (ed). Türkiye’de konjenital malformasyon sıklığı, dağılımı, risk faktörleri ve yenidoğanların antropometrik değerlen- dirilmesi. Ankara: TÜBİTAK Matbaası; 1996:94.
5. Aydınlı E. “Tek taraflı dudak-damak yarıklı olgularda ortopedik tedavi ve sekonder kemik grefti uygulamasının çene-diş-yüz Kompleksi üzerindeki etkilerinin değerlen- dirilmesi”, Doktora Tezi, E.Ü Dişhekimliği Fakültesi, 2008.
6. Fraser FC. The genetics of cleft lip and cleft palate. Am J Hum Genet 1970; 22(3): 336-352.
7. Murray JC, Daack-Hırsch S, Buetow KH, Munger R, Espina L. Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Cleft Plate Craniofac J 1997; 34(1): 7-10.
8. Grayson B, Maull D, “Nasoalveolar Molding for Infants Born with Clefts of the Lip, Alveolus, and Palate”, Seminars in plastic surgery, 2005, 19: 294-301

9. Grayson BH, Shetye PR. Presurgical nasoalveolar molding treatment in cleft lip and palate patients. Indian J Plast Surg (supp). 2009; 42:s56-61.
10. Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999; 36(6): 486-498.
11. Santiago PE, Grayson BH, Cutting CB, Gianoutsos MP, Brecht LE, Kwon SM. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty. Cleft Palate Craniofac J 1998; 35(1): 7-80.
12. Grisius TM, Spolyar J, Jackson IT, Bello-Royas G, Dajani K. Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures. J Craniofac Surg, 2006;17(3): 468-473.
13. Lo L. Primary Correction of the Unilateral Cleft Lip Nasal Deformity Achieving the Excellence. Chang Gung Med J, 2006, 29, 262-267.
14. Mazaheri M, Harding RL, Cooper JA, Meier JA, Jones TS. Changes in arch form and dimensions of cleft patients. Am J Orthod. 1971; 60:19–32.
15. Braumann B, Keilig L, Stellzig- Eisenhauer A, Bourauel C, Berge S, Jager A. Patterns of maxillary alveolar arch growth changes of infants with unilateral cleft lip and palate: preliminary findings. Cleft Palate Craniofac J. 2003;40:363–372.
16. Reiser E, Skoog V, Andlin-Sobocki A. Early Dimensional Changes in Maxillary Cleft Size and Arch Dimensions of Children With Cleft Lip and Palate and Cleft Palate. The Cleft Palate-Craniofacial Journal 2013; 50(4):481–490.
17. Suri S, Tompson B. A Modified Muscle-Activated Maxillary Orthopedic Appliance for Presurgical Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate. Cleft Palate–Craniofacial Journal, 2004, 41, 227-229.
18. Stellzig A, Basdra EK, Hauser C, Hassfeld S, Komposch G. Factors influencing changes in maxillary arch dimensions in unilateral cleft lip and palate patients until six months of age. Cleft Palate Craniofac J 1999; 36(4): 304-309.
19. Ball JV, DiBiase DD, Sommerlad BC. Transverse maxillary arch changes with the use of preoperative orthopedics in unilateral cleft palate infants. Cleft Palate Craniofac J. 1995;32(6):483-488.
20. Sabarinath VP, Thombare P, Hazarey PV, Radhakrishnan V, Agrekar S. Changes in maxillary alveolar morphology with nasoalveolar molding. Dent. 2010;35(2):207-212. J Clin Pediatr
21. Adali N, Mars M, Noar J, Sommerlad B. Presurgical Orthopedics Has No Effect on Archform in Unilateral Cleft Lip and Palate. Cleft Palate–Craniofacial Journal. 2012; 49 (1):5-13.
22. Grayson B H, Garfinkle JS. Early cleft management: The case for nasoalveolar molding. Am J Orthod 2014; 145(2):134-142.