title: Presurgical nasoalveolar molding in patients with unilateral clefts of lip, alveolus and palate. Case study and review of the literature.
abstract: BACKGROUND
  The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty.
  
  
  METHODS
  Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery.
  
  
  CONCLUSIONS
  Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.
authors.affiliation: Department of Orthodontics, Preventive and Pediatric Dentistry, Ernst Moritz Arndt University of Greifswald, Germany. antje.kirbschus@uni-whde
authors.forename: Antje
authors.initials: A
authors.lastname: Kirbschus
authors.forename: Dietmar
authors.initials: D
authors.lastname: Gesch
authors.forename: Annegret
authors.initials: A
authors.lastname: Heinrich
authors.forename: Tomas
authors.initials: T
authors.lastname: Gedrange
mesh_terms: D000539:Alveolar Process / Q000002:abnormalities / Q000601:surgery; D002971:Cleft Lip / Q000628:therapy*; D002972:Cleft Palate / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008046:Lip / Q000002:abnormalities / Q000601:surgery; D009666:Nose / Q000473:pathology / Q000601:surgery*; D010158:Palatal Obturators; D011300:Preoperative Care / Q000379:methods*