Presurgic Al Nasoalveolar Molding Devices With Nasal Stents And Retention ARM In Complete Unilateral Cleft LIP And Palate Treatment In The Preoperative Evaluation Of The Application And Effect

Objective:To investigate the application and orthopaedic effect of presurgical nasoalveolar molding (PNAM) devices with nasal stent and retention arm on the nasolabial and palatal deformities in complete unilateral cleft lip and palate patients (UCCLP), which the correction of nasolabial and palatal deformities has been finished simultaneously.Clinical Materials and Methods:A retrospective review was conducted at Children’s Hospital of Chongqing Medical University from Jan2008to Dec2010.14cases were selected respectively in three groups, which met the inclusion criteria. Among them, the cases in the study group (group A) were treated with modified PNAM appliances with nasal stent and retention arm within1month after birth until cheilorrhaphy has been finished about three months old; and the patients in positive control group (group B) failed to undergo PNAM treatment for various reasons; and the nasolabial and palatal development of objects in normal group (group C) is normal with about three months old. The anatomic points on the photos of standard anteroposterior and mentonasal positions of face and palatal casts were marked, then the distance, angle and area were measured. The paired t-test and multivariate analysis of variance were used to evaluate the effect on the nasolabial and palatal deformities.Part I:To explore the fabrication, insertion, adjustment, complication, and other problems of the PNAM devices with nasal stent and retention arm by the continuous observation of14cases in the study group, which met the inclusion criteria. And the orthopaedic effects were valuated subjectively.Part Ⅱ:The photos of standard anteroposterior and mentonasal positions were obtained under the anesthesia, which included the cases in group A before and after PNAM, the patients in group B before cheilorrhaphy and the objects in the group C. The anatomic points on the photos were marked, and then the distance, angle and area were measured. The paired t-test and multivariate analysis of variance were used to evaluate the effect on the nasolabial deformities. All statistics were performed using statistical computer software (SPSS18.0, SPSS Inc.)Part Ⅲ:The photos of standard normotopia of maxillary casts were obtained, which included the cases in group A before and after PNAM, the patients in group B before cheilorrhaphy and the objects in the group C. The anatomic points on the photos were marked, and then the distance, angle and area were measured. The paired t-test and multivariate analysis of variance were used to evaluate the effect on the nasolabial deformities. All statistics were performed using statistical computer software (SPSS18.0, SPSS Inc.)Results:Part Ⅰ:The PNAM device with nasal stent and retention arm has many advantages, such as simple manufacture, cheap, convenient use and modified, etc. And the nasolabial and palatal deformities can be improved significantly. But some problems still existed, which included mucosal bleeding and ulcer, fungal infections, contact dermatitis and other complications.Part Ⅱ:PNAM treatment can make the NTH, CL, CW, NHL, NHR, NWL, NWR, NRCL, NRCR, NAL, NAR and LLA of UCCLP patients significantly increased (P<0.05), and BAHD, CWN, NBD and CD of UCCLP patients significantly decreased (P<0.05). Nonetheless there was a difference with the cases in group C (P<0.05). And NHR, NRCR, NAR and LLA of the patients in group B had an increasing trend, which compared with the cases in group A before PNAM treatment (P<0.05). Multivariate analysis of variance found that four indicators have no statistically significant difference (p>0.05), which included EnW, BAW, CHW, NWR.Part III:PNAM treatment can make the AW, AC and PA of UCCLP patients significantly increased (P<0.05), and CPW, CWA, CWAS, CWAT, PMD and CA of UCCLP patients significantly reduced (P<0.05). Howevef, there was a difference with the cases in group C (P<0.05). And AW, CPW, CA and PA of the patients in group B had an increasing tendency, which compared with the cases in group A before PNAM treatment (P<0.05). Multivariate analysis of variance found TW has no statistically significant difference (p>0.05).Conclusion:The PNAM device with nasal stent and retention arm can effectively correct the nasolabial and palatal deformities of UCCLP patients simultaneously, and improve the nasolabial morphology, and restore the triangular structure and the symmetry of the abnormal noses, and replace and align the alveolar segments, remodel the palatal morphology, and reduce the severity of the primary deformity. PNAM is one of non-surgical, inital treatments for valid improving the nasolabial and palatal deformities of UCCL patients.