Thakur Seema, Jishad C, Singhal Parul, Chauhan Deepak
Department of Pediatric and Preventive Dentistry, HP Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
Dent Res J (Isfahan). 2021 Aug 18;18:68. eCollection 2021.
Presurgical nasoalveolar molding (PNAM) was introduced by Grayson ., in 1993 to presurgically mold the alveolus, lip, and nose in infants with cleft lip and palate (CLP). The aim of this comparative clinical trial was to evaluate the efficacy and efficiency of Modified and Conventional Grayson's PNAM in patients concerning morphological and anatomical changes in maxillary alveolus, nasal symmetry, number of visits, and duration of treatment.
In this comparative clinical trial study, 16 infants with unilateral complete CLP were equally divided into two groups: Group I (modified PNAM technique using titanium molybdenum alloy [TMA] wire nasal stent) and Group II (conventional PNAM technique using stainless steel wire nasal stent). Patient photographic evaluation of nasal symmetry and maxillary study model CAD-CAM analysis, pre- and post-operatively in both groups, were compared using a paired -test between the groups using the Chi-square test with < 0.05 as statistically significant.
In both groups, on evaluating nasal measurements, statistically significant ( < 0.05) decrease in nasal width and increase in columella deviation angle, a decrease of nostril length, and an increase of columella length in Group I were observed. On maxillary study model evaluation, a statistically significant ( < 0.05) decrease in width of the alveolar cleft was noticed in both groups and lateral deviation of the incisal point in Group I and width of the palatal cleft in Group II was noticed.
This study showed a morphological improvement in nasal symmetry and maxillary alveolar morphology in complete unilateral CLP patients, treated with both Modified and Conventional PNAM techniques, with the Modified PNAM technique being more efficient for treatment duration and the number of adjustments as there are less number of visits.
1993年，格雷森等人引入了术前鼻牙槽塑形（PNAM）技术，用于在唇腭裂（CLP）婴儿术前对牙槽、唇和鼻进行塑形。这项比较临床试验的目的是评估改良型和传统格雷森PNAM在患者上颌牙槽形态和解剖结构变化、鼻对称性、就诊次数和治疗持续时间方面的疗效和效率。
在这项比较临床试验研究中，16名单侧完全性唇腭裂婴儿被平均分为两组：第一组（使用钛钼合金[TMA]丝鼻支架的改良PNAM技术）和第二组（使用不锈钢丝鼻支架的传统PNAM技术）。两组患者术前和术后均通过鼻对称性的照片评估和上颌研究模型CAD-CAM分析进行比较，组间比较采用配对检验，卡方检验，P<0.05为有统计学意义。
在两组中，评估鼻测量值时，观察到第一组鼻宽度有统计学意义（P<0.05）的减小、鼻小柱偏斜角增大、鼻孔长度减小和鼻小柱长度增加。在上颌研究模型评估中，两组牙槽裂宽度均有统计学意义（P<0.05）的减小，第一组观察到切牙点的侧向偏斜，第二组观察到腭裂宽度。
本研究表明，采用改良型和传统PNAM技术治疗的完全性单侧唇腭裂患者，鼻对称性和上颌牙槽形态均有形态学改善，改良型PNAM技术在治疗持续时间和调整次数方面更有效，因为就诊次数较少。
