Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China.
Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China.
J Clin Pediatr Dent. 2023 Nov;47(6):155-162. doi: 10.22514/jocpd.2023.090. Epub 2023 Nov 3.
Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subphenotypes among nonsyndromic cleft lip and/or palate (NSCL/P), that complicates surgical repair operations. Presurgical nasoalveolar molding (PNAM) is a technique used to reshape the nose, lip and alveolar bone of infants with UCCLP before surgery (the modified Mohler rotation advancement cheiloplasty and two flap palatoplasty), with the potential to facilitate surgical repair. However, the effectiveness of PNAM treatment is still a matter of debate. In this paper, the 3Shape scanning system and 3dMD stereophotography were used to assess the short-term and long-term effects of PNAM treatment on the dental arch morphology and nasolabial features of patients with UCCLP, respectively. The findings indicated that PNAM treatment negatively affects both short-term and long-term dental arch shape compared to the treatment without PNAM, particularly in terms of limiting the transverse width of the maxillary canine-to-midline. Regarding the nasal and labial symmetry, PNAM improves the symmetry of the nasal alae in patients over 7 years old and the symmetry of the lip in patients under 7 years old. Moreover, UCCLP patients who received PNAM treatment exhibited a shorter and wider shape of the nostril on the cleft side compared to those without PNAM treatment. In clinical practice, the multidisciplinary team should carefully consider the advantages and disadvantages of the outcomes of PNAM treatment when treating infants with cleft lip and palate.
单侧完全性唇腭裂（UCCLP）是一种非综合征性唇腭裂（NSCL/P）中最严重的临床亚型之一，会使手术修复变得复杂。术前鼻牙槽塑形术（PNAM）是一种用于在手术前重塑单侧完全性唇腭裂婴儿的鼻子、嘴唇和牙槽骨的技术（改良的 Mohler 旋转推进瓣唇裂修复术和两瓣腭裂修复术），有潜力促进手术修复。然而，PNAM 治疗的效果仍然存在争议。本文分别使用 3Shape 扫描系统和 3dMD 立体摄影术来评估 PNAM 治疗对 UCCLP 患者牙弓形态和鼻唇特征的短期和长期效果。研究结果表明，与不进行 PNAM 治疗相比，PNAM 治疗对短期和长期的牙弓形状都有负面影响，特别是在限制上颌尖牙到中线的横向宽度方面。就鼻唇对称性而言，PNAM 改善了 7 岁以上患者鼻翼的对称性和 7 岁以下患者嘴唇的对称性。此外，接受过 PNAM 治疗的 UCCLP 患者在裂隙侧的鼻孔呈现出更短和更宽的形状，而未接受过 PNAM 治疗的患者则呈现出更长和更窄的形状。在临床实践中，多学科团队在治疗唇腭裂婴儿时应仔细考虑 PNAM 治疗结果的优缺点。
