Presurgical orthopaedic nasoalveolar molding in cleft lip and palate infants: a comparative evaluation of cases done with and without nasal stents.

Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.