EVALUATION OF NASOALVEOLAR MOLDING THERAPY ON MAXILLARY ARCH FORM IN INFANTS WITH UNILATERAL CLEFT LIP AND PALATE WITH DIGITAL MODELING

Year 2025, Volume: 49 Issue: 3 , 143 - 149 , 12.12.2025

Aslıhan Zeynep Öz , İlknur Can , Fatmanur Sönmaz Cural

https://doi.org/10.65022/clindentres.1716782

https://izlik.org/JA65SZ76KH

Abstract

Background and Aim: Nasoalveolar molding (NAM) is considered a routine part of pre-surgical orthopedic treatment protocols for patients with cleft lip and/or palate (CLP). Treating this deformity from birth to adulthood requires a multidisciplinary approach to achieve optimal aesthetics and function. This study aims to evaluate the effects of NAM therapy on the cleft segments in infants with unilateral CLP using digital modeling.
Materials and Methods: The study included 30 patients with unilateral CLP, who completed NAM treatment and had pre- and post-treatment maxillary plaster models. These models were scanned with a model scanner to create digital models. Linear and angular measurements were made on the digital models to
determine changes in the cleft width and the positions of the segments.
Results: There was a significant decrease in the cleft width with NAM treatment (p<0.05). A significant decrease in intercanine distance was observed (p<0.05), while the intertuber distance was increased. A significant difference was found in the medial rotation of the larger segment before and after NAM (p<0.05), while no significant difference was observed in the lesser segment (p>0.05). In maxillary depth measurements, a significant decrease was observed in the larger segment (p<0.05), whereas no significant difference was found in the lesser segment (p>0.05).
Conclusions: Pre-surgical NAM therapy contributes to the approximation of the cleft segments, facilitates the medial rotation of the larger segment towards the midline, and thus, helps achieve a more uniform arch form.

Keywords

Unilateral cleft lip and palate , Nasoalveoler molding , Presurgical orthopedic treatment , Digital models

References

• 1. Owens J, Jones J, Harris F. Epidemiology of facial clefting. Arch Dis Child 1985; 60: 521-524.
• 2. Jiang R, Bush JO, Lidral AC. Development of the upper lip: morphogenetic and molecular mechanisms. Dev Dyn: an official publication of the Am Assoc Anatomists 2006; 235: 1152-1166.
• 3. Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet 2011; 12: 167-178.
• 4. Babai A, Irving M. Orofacial clefts: genetics of cleft lip and palate. Genes 2023; 14: 1603.
• 5. Salari N, Darvishi N, Heydari M, Bokaee S, Darvishi F, Mohammadi M. Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2022; 123: 110-120.
• 6. Yılmaz HN, Özbilen EÖ, Üstün T. The prevalence of cleft lip and palate patients: a single-center experience for 17 years. Turk J Orthod 2019; 32: 139.
• 7. Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999; 36: 486-498.
• 8. Mishima K, Sugahara T, Mori Y, Sakuda M. Three-dimensional comparison between the palatal forms in infants with complete unilateral cleft lip, alveolus, and palate (UCLP) with and without Hotz’s plate. Cleft Palate Craniofac J 1996; 33: 77-83.
• 9. Dibbell DG. Cleft lip nasal reconstruction: correcting the classic unilateral defect. Plast Reconst Surg 1982; 69: 264-270.
• 10. Burgaz MA, Cakan DG, Yılmaz RBN. Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study. Korean J Orthod 2019; 49: 286-298.
• 11. Grayson BH, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconst Surg 1993; 92: 1422- 1423.
• 12. Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J 2001; 38: 193-198.
• 13. Burston W. The early treatment of cleft palate conditions. Dent Prac 1958; 9: 41-56.
• 14. Grayson BH, Maull D. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate. Clin Plast Surg 2004; 31: 149-158.
• 15. Pfeifer TM, Grayson BH, Cutting CB. Nasoalveolar molding and gingivoperiosteoplasty versus alveolar bone graft: an outcome analysis of costs in the treatment of unilateral cleft alveolus. Cleft Palate Craniofac J 2002; 39: 26-29.
• 16. 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: 77-80.
• 17. Keçik D, Enacar A. Effects of nasoalveolar molding therapy on nasal and alveolar morphology in unilateral cleft lip and palate. J Craniofac Surg 2009; 20: 2075-2080.
• 18. Sabarinath V, Thombare P, Hazarey P, Radhakrishnan V, Agrekar S. Changes in maxillary alveolar morphology with nasoalveolar molding. J Clin Pediatr Dent 2010; 35: 207-212.
• 19. Braumann B, Keilig L, Bourauel C, Jäger A. Three-dimensional analysis of morphological changes in the maxilla of patients with cleft lip and palate. Cleft Palate Craniofac J 2002; 39: 1-11. 149.
• 20. Braumann B, Rosenhayn SE, Bourauel C, Jäger A. Two-or threedimensional cast analysis in patients with cleft lip and palate? J Orofac Orthop 2001; 62: 451-465.
• 21. Yu Q, Gong X, Shen G. CAD presurgical nasoalveolar molding effects on the maxillary morphology in infants with UCLP. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116: 418-426.
• 22. Akdeniz BS, Aykaç V, Turgut M, Çetin S. Digital dental models in orthodontics: A review. J Clin Exp Med 2022; 39: 250-255.
• 23. Berkowitz S. Cleft lip and palate. Berlin: Springer-Verlag; 2006.
• 24. Mandwe RS, Puri S, Shingane S, Pawar G, Kolhe VR, Alsi A. Presurgical nasoalveolar remodeling–an experience in the journey of cleft lip and palate. Clin Cosmet Investig Dent 2014: 1-7.
• 25. Liou EJ-W, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconst Surg 2004; 114: 858- 864.
• 26. Barillas I, Dec W, Warren SM, Grayson BH. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip– cleft palate patients. Plast Reconst Surg 2009; 123: 1002-1006.
• 27. Baek SH, Son WS. Difference in alveolar molding effect and growth in the cleft segments: 3-dimensional analysis of unilateral cleft lip and palate patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 160-168.
• 28. Wood RJ, Grayson BH, Cutting CB. Gingivoperiosteoplasty and midfacial growth. Cleft Palate Craniofac J 1997; 34: 17-20.
• 29. Huddart A. Presurgical changes in unilateral cleft palate subjects. Cleft Palate J 1979; 16: 147-157.
• 30. 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: 483-488.