Complex Correction of Complete Cleft Lip with Severe Prominent Premaxilla using Lip Adhesion and Nasoalveolar Molding Device

Abstract

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.

Keywords: Case reports; Cleft lip; Orthodontic appliances.

Fig. 1. The device for presurgical nasoalveolar molding. It included an intraoral molding acrylic palatal plate and nasal stent. The stent had a spherical soft resin molding ball attached to the intraoral palatal plate with 0.036 inch diameter wire.

Fig. 2. Measurement of dental cast: M, most anterior point of the noncleft side maxilla on the gingival ridge of the cleft; M', most anterior point of the cleft side maxilla on the gingival ridge of the cleft; T, maxillary tuberosity of the major segment; T', maxillary tuberosity of the minor segment. The degree of protruding premaxilla (P)=distance (A) of point M and line TT'-distance (a) of point M' and line TT'.

Fig. 3. Case 1. Photographs of unilateral cleft lip infant. (A) Preoperative view of 87-day-old baby. Protruding premaxilla and slightly deviated columella were seen. (B) Postoperative view on 9 month-old baby following cheiloplasty. There is no columella lengthening and asymmetric nostril and depressed alar contour was seen.

Fig. 4. Case 2. Photographs of bilateral cleft lip infant. (A) Three weeks of age prior to lip adhesion and nasoalveolar molding appliance therapy. (B) At 12 month of age of the same patient. Realigngment of premaxilla to lateral segments, columellar lengthening and improved alar dome contour was noted.

Fig. 5. Case 3. (A) Preoperative view of 20-day-old baby with complete unilateral cleft lip and protruding premaxilla, which presents outward rotation of the major segment and a posterior positioning of the minor segment. (B) Postoperative view on 168 days following the nasoalveolar molding device and lip adhesion. The alignment of maxillary alveolar arch is improved.