Rehabilitation of cleft with nasoalveolar molding- A case report

Facial cleft is the second most common congenital deformity. Problems of cleft can be related to esthetic, phonetics, functional insufficiency, emotional, psychological and social. Significant abnormality in nasal cartilage morphology and asymmetry of alar base and columella are associated with cleft lip and alveolar deformity. Pre Nasoalveolar molding (PNAM) is a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and palate surgery, which decrease the severity of the cleft. A 05 days old unilateral cleft lip and palate child was referred by plastic and reconstructive surgeon for presugical management. Child was having unilateral cleft of lip, alveolus and palate of left side with shorter columella on cleft side with gap between alveolus of 10 mm. The alar cartilage of left side was depressed and there was the deviation of columella towards the right side. Presurgical nasoalveolar molding was planned for the child. Once the child was adapted and was able to easily suckle without gagging, the activation of the appliance was done. After 06 weeks nasal component was added to the appliance. The goals of PNAM in the unilateral child are to align and approximate the intraoral alveolar segments and to correct the malposition of the nasal cartilages.