Management of Unilateral Cleft Lip and Palate using Presurgical Nasoalveolar-Molding

Ista Meidarlina, Gian Nur Alamsyah

Abstract


Cleft lip and palate (CLP) is a common congenital defect in craniofacial. The patient with  CLP experiences difficulty in breastfeeding which can affect their nutritional status. The presurgical nasoalveolar molding (PNAM) is a device used to overcome this problem. This case report aims to describe the pre-surgical treatment using PNAM with a Hotz-Kogo modification design.  This case report presented a two-week-old infant who had unilateral CLP. The alar base widened, the pro-labium and columella were shortened on one side and tilted towards the non-cleft side, and the minor segment of the maxilla was hypoplastic and retroposition. This patient experienced difficulty in breastfeeding and will be treated with PNAM with ekstra oral strapping and nasal stent. The PNAM was adjusted regularly. After using PNAM, the patient had a good sucking reflex and was easy to breastfeed, the position of the premaxilla was corrected, and the nasal morphology was more symmetrical before labioplasty. The presurgical PNAM is a device that functions as a feeding aid to help the baby get good nutrition and also as a pre-surgical treatment to reduce the severity of oronasal deformity before surgery.


Keywords


Cleft lip and palate, Extra-oral strapping, Labiognatopalatoschizis, Nasal stent, Presurgical nasoalveolar molding

References


References

Mairaj K, Ahmed AHB, Taioli E. Epidemiology of cleft lip and palate. Intech open. 2017;3–22.

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 [Internet]. 2022;123(2):110–20. Available from: https://doi.org/10.1016/j.jormas.2021.05.008

Moeloek NF. Pedoman nasional pelayanan kedokteran tata laksana bibir sumbing dan lelangit. Keputusan Menteri Kesehat Republik Indones. 2019;0107(321):1–44.

Vyas T, Gupta P, Kumar S, Gupta R, Gupta T SH. Cleft of lip and palate: A review. J Fam Med Prim Care. 2020;9(6):2621–5.

Fell M, Dack K, Chummun S, Sandy J, Wren Y, Lewis S. Maternal cigarette smoking and cleft lip and palate: A systematic review and meta-analysis. Cleft Palate-Craniofacial J. 2022;59(9):1185–200.

Reynolds K, Zhang S, Sun B, Garland MA, Ji Y, Zhou CJ. Genetics and signaling mechanisms of orofacial clefts. Birth Defects Res. 2020;112(19):1588–634.

Babai A, Irving M. Orofacial clefts: Genetics of cleft lip and palate. Genes (Basel). 2023;14(8):1–13.

Staudt CB, Bollhalder J, Eichenberger M, La Scala G, Herzog G, Wiedemeier DB, et al. Final posttreatment occlusion in patients with unilateral cleft lip and palate. Cleft Palate-Craniofacial J. 2022;59(7):899–909.

Taylor TD. Clinical maxillofacial prosthetics [Internet]. Lori A. Bateman, editor. Angewandte Chemie International Edition, 6(11), 951–952. illinois: Quintessence Publishing Co, Inc; 2000. 63–84 p. Available from: https://vdoc.pub/download/clinical-maxillofacial-prosthetics-37hrp4nomcb0

Yin J, Zhang S, Huang N, Shi B, Zheng Q, Yang C. Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study. Front Pediatr. 2022;10(December):1–5.

Alamsyah GN, Damayanti L, Sumarsongko T. Presurgical nasoalveolar molding modifikasi Hotz-Kogo dengan single nasal stent untuk perawatan pra-bedah bayi celah bibir dan langit-langit unilateral komplit. J Kedokt Gigi Univ Padjadjaran. 2022;33(3):12.

Mandwe RS, Puri S, Shingane S, Pawar G, Ramdas Kolhe V, Alsi A. Presurgical nasoalveolar remodeling - An experience in the journey of cleft lip and palate. Clin Cosmet Investig Dent. 2015;7:1–7.

Shi B, Losee JE. The impact of cleft lip and palate repair on maxillofacial growth. Int J Oral Sci [Internet]. 2015;7(1):14–7. Available from: http://dx.doi.org/10.1038/ijos.2014.59

Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and palate orthopedics: An overview. Clin Cosmet Investig Dent. 2017;9:53–9.

Thakur S, Jishad C, Singhal P, Chauhan D. Comparative clinical evaluation of modified and conventional Grayson’s presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate. Dent Res J (Isfahan). 2021;18(1).

Michael AI, Olorunfemi G, Olusanya A, Oluwatosin O. Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study. PLoS One [Internet]. 2023;18(1 January):1–16. Available from: http://dx.doi.org/10.1371/journal.pone.0274657

Mink van der Molen AB, van Breugel JMM, Janssen NG, Admiraal RJC, van Adrichem LNA, Bierenbroodspot F, et al. Clinical practice guidelines on the treatment of patients with cleft lip, alveolus, and palate: An executive summary. J Clin Med. 2021;10(21).

Kinouchi N, Horiuchi S, Yasue A, Kuroda Y, Kawai N, Watanabe K, et al. Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity. Saudi Med J. 2018;39(2):169–78.

Zuhaib M, Bonanthaya K, Parmar R, Shetty PN, Sharma P. Presurgical nasoalveolar moulding in unilateral cleft lip and palate. Indian J Plast Surg. 2016;49(1):42–52.

M Kogo , G Okada, S Ishii, M Shikata, S Iida TM. Breast feeding for cleft lip and palate patients, using the hotz-type plate. Cleft Palate-Craniofacial J [Internet]. 1997;34(4):351–3. Available from: https://pubmed.ncbi.nlm.nih.gov/9257027/




DOI: https://doi.org/10.33854/jbd.v12i1.1738

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