Nasoalveolar Molding with Modified Orthopedic Plate at the Cleft Centre of Childrens Hospital & Institute of Child Health, Lahore

Objective was to introduce a modified appliance and treatment protocol for presurgical nasoalveolar molding in a new born baby presenting with unilateral cleft of the lip and palate. This treatment comprises use of an orthopedic plate with acrylic nasal stent, in combination with adhesive steri-strip. The plate is adjusted every week for alveolar molding. For nasal molding, soft acrylic is added incrementally to the acrylic nasal stent in order to lift the alar dome cartilage and to mold the depressed and concave lower lateral cartilage on the affected side. Activation was done on weekly basis till the age of three months. The plate prevented cleft widening effect of the tongue and utilized the functional movements of the orofacial musculature to guide and relocate the major segment medially to its normal position. Reduction of 4.5mm was attained in the anterior region of the cleft gap by this device. The shape of cartilaginous septum, alar tip and medial and lateral crus were molded to resemble the near normal shape of these structures. The technique helps to improve alveolar position, nasal septum alignment, nasal symmetry and nasal tip projection prior to lip repair. This device minimizes lip scar and results in aesthetic outcome of the patient.