EFFECT OF CAD/CAM NASOALVEOLAR MOLDING APPLIANCE ON CORRECTION OF THE NASAL DEFORMITY IN COMPLETE BILATERAL CLEFT LIP AND PALATE

Introduction: Cleft lip and palate (CLP) affects about 1.5 per 1000 live births (250,000 new cases per year) worldwide. They can be either unilateral or bilateral, complete or incomplete. The bilateral cleft lip and palate (BCLP) deformity typically arises with a protrusive premaxilla. The nasal deformity includes deficient columella, with flared lateral alar cartilages which usually require additional surgeries to improve the nasal symmetry. NasoAlveolar Moulding (NAM) technique, aims to align the alveolus, lip, and nose properly; reduce the severity of the nasal deformity, and lengthen the columella without surgery. Objectives: The study aims to quantify the effect of NAM therapy, fabricated by CAD/CAM additive manufacturing, in the improvement of nasolabial deformity in terms of bialar width, columellar length and width in infants with complete BCLP. Materials and methods: Ten infants with non-syndromic BCLP (age < 1 month) were selected. Impressions were obtained. The casts obtained from the impressions were scanned using a 3D laser scanner. Designing and 3D printing of the appliances were completed. The appliances were inserted and retained using surgical tapes. Nasal stents were incorporated 60 days after the start of the treatment. Nasal measurements were obtained before treatment and at the end of treatment (after four months). Results:Data was collected and statistically analyzed. After NAM therapy, there was a statistically significant increase in columellar length and a statistically significant decrease in both columellar width and bialar width. Conclusions: CAD/CAM PNAM therapy has proved its effectiveness in BCLP by showing an improvement in the columellar and bialar presurgical presentation. CAD/CAM PNAM therapy should be considered a routine procedure in the treatment protocol for BCLP.