Bangun Kristaninta, Tania Vika, Kreshanti Prasetyanugraheni, Pancawati Julieta, Mihardjanti Marini, Halim Jessica, Cendrick Windy
Department of Surgery, Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine Universitas Indonesia, Cleft and Craniofacial Center.
Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
J Craniofac Surg. 2025 May 1;36(3):956-960. doi: 10.1097/SCS.0000000000010762. Epub 2024 Oct 14.
To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP).
Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management.
This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2).
The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 ( P < 0.0001), whereas the rest did not show significant differences in value following NAM application ( P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83 mm on average.
Naso-alveolar molding can push back the premaxillary protrusion up to 5 mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.
评估鼻牙槽塑形（NAM）在双侧唇腭裂（BCLP）患者中推动前颌骨后移的程度。
在唇腭裂病例中应用鼻牙槽塑形可闭合裂隙间隙并增加鼻尖突出度。在双侧唇腭裂中，鼻牙槽塑形有可能推动前颌骨后移，以实现无张力的一期唇裂修复。然而，一些有鼻牙槽塑形史的双侧唇腭裂患者在唇裂修复术中仍需要进行截骨术，这对鼻牙槽塑形在双侧唇腭裂治疗中的疗效提出了质疑。
本单中心回顾性研究使用了非综合征性双侧唇腭裂患者的病历。在5年期间纳入了26例双侧唇腭裂患者，这些患者在一期唇裂修复术前有鼻牙槽塑形应用史。在两个时间点对前颌骨宽度（P）、前牙弓宽度（A）、后牙弓宽度（R）和前颌骨的前后突出度（P'-A'）的变化进行了统计分析：（1）在开始鼻牙槽塑形时（T1）和（2）在手术前完成鼻牙槽塑形后（T2）。
开始鼻牙槽塑形时的平均年龄为46.2±40.4天，鼻牙槽塑形的平均使用时间为125.14±62.94天。A和P-A在T1和T2之间存在显著差异（P<0.0001），而其余指标在应用鼻牙槽塑形后的值没有显著差异（P>0.05）。鼻牙槽塑形成功地将前颌骨部分平均后推了约4.68±2.83毫米。
鼻牙槽塑形可将前颌骨突出度后推达5毫米，这可作为考虑联合治疗方式的临界点。产前诊断、咨询和腭裂教育应成为腭裂治疗中心改善患者整体预后的基准。
