Korean J Orthod.  2019 Sep;49(5):286-298. 10.4041/kjod.2019.49.5.286.

Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: A case-control study

• Burgaz MA
• Cakan DG
• Yılmaz RB

• KMID: 2458617
• DOI: http://doi.org/10.4041/kjod.2019.49.5.286

Abstract

OBJECTIVE
The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts.
METHODS
A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: 14.20 ± 8.09 days and 118.16 ± 10.06 days, respectively) comprised the treatment group, while 26 infants without clefts (mean age: 115.81 ± 8.71 days) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0.
RESULTS
During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group.
CONCLUSIONS
During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.

Keyword

Unilateral cleft lip and palate; Nasoalveolar molding; Three-dimensional analysis; Alveolar changes

MeSH Terms

Case-Control Studies*
Cleft Lip*
Fungi*
Humans
Infant*
Palate*
Vertical Dimension

Figure

• 

  Figure 1 Positioning of landmarks for the measurement of alveolar changes after nasoalveolar molding in infants with unilateral cleft lip and palate. A, The landmarks are positioned on a maxillary virtual model using Mimics software, version 17.0 (Materialise, Leuven, Belgium). After positioning on the three-dimensional model, the location of each landmark (in this figure, B point) was two-dimensionally checked in the axial, sagittal, and coronal planes. B, For evaluation of the vertical deviations, a horizontal plane is constructed using the following three points: 1) greater segment tuberosity point (T), 2) lesser segment tuberosity point (T′), and 3) greater segment canine point (C2). See Table 1 for definitions of each landmark.

• 

  Figure 2 Alveolar segmentation for the measurement of changes after nasoalveolar molding in infants with unilateral cleft lip and palate. The alveolar segments are separated from the maxillary virtual model 5 mm below the horizontal reference plane. For volumetric measurements, the segments are sectioned using the I, C1, C2, and C2′ volumetric planes. See Table 1 for definitions of each landmark.

• 

  Figure 3 Transverse and sagittal measurements after nasoalveolar molding in infants with unilateral cleft lip and palate. A, Transverse linear and angular measurements. B, Sagittal measurements. 1, Anterior cleft width (A-A′); 2, anterior arch width (C2-C2′); 3, inferior anterior arch width (G-G′); 4, posterior cleft width (P-P′); 5, posterior arch width (T-T′); 6, posterior position of the greater segment (Z-T-C2); 7, posterior position of the lesser segment (Z-T′-C2′); 8, greater segment rotation (I-Z-T); 9, anterior arch depth (I-AnP); 10, anterior position of the greater segment (I-Z); 11, total arch depth (I-PoP); 12, alveolar arch length in the lesser segment (A′-PoP); 13, canine-posterior plane distance in the greater segment (C2-PoP); 14, canine-posterior plane distance in the lesser segment (C2′-PoP).

• 

  Figure 4 Vertical deviations after nasoalveolar molding (NAM) in two different representative cases with unilateral cleft lip and palate. A, Increased vertical deviations after treatment. In this patient, the initial vertical deviations did not improve with treatment, probably because of the excessive vertical component of the extraoral force caused by inappropriate use of the retention tapes or individual differences in the amount of tissue deficiency and growth potential. B, Decreased vertical deviations after treatment. In this patient, a significant decrease has occurred as a result of vertical trimming inside the appliance and growth during the treatment. T0, Before treatment; T1, after treatment.

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