A new approach in presurgical infant orthopedics using modified nostril retainers in the management of unilateral cleft lip and palate patient
Usak University, Turkey
: J Otol Rhinol
Statement of the Problem: Cleft lip and palate are congenital defects of the middle third of the face. In Grayson technique for nasal molding, intraoral plate insertion is mandatory for nasal correction. A nasal stent is added when the cleft width is decreased to 5 mm. We used modified nostril retainers instead of nasal stents for nasal molding which enables the separation of the nasal molding and intraoral plate insertion. The aim of this study was to describe a new approach to the traditional method of PNAM for unilateral cleft lip and palate (UCLP) patients. Methodology & Theoretical Orientation: We used modified nostril retainers to treat 16 UCLP newborn patients with different cleft widths. The modified nostril retainer was manufactured from soft acrylic using a special mold without taking an impression of the nose. Patients with a cleft width of less than 6 mm (10 patients) were treated with modified nostril retainers without oral palate and patients with a cleft width equal or more than 6 mm (6 patients) were treated with modified nostril retainers with an oral palate. The modified nostril retainers were applied at the first visit of the patient regardless of the amount of the cleft width. Weekly activation was performed by adding soft acrylic to the cleft side of the modified nostril retainer. Findings: The symmetry of the nose of each patient had improved. In all patients cleft segments touched to each other. Conclusion & Significance: Different from the nasal stents, the modified nostril retainers apply upward and forward forces to both sides of the columella that can accelerate the uprigthing of the columella. In the modified method, early start of nasal molding and the short duration of the treatment can prevent memory fixation of the cartilage and tissue. Recent Publications 1. Titiz S and Aras A (2017) Presurgical orthopedic treatment using modified nostril retainers in patients with unilateral cleft lip with or without cleft palate. Journal of Craniofacial Surgery 28(6):1570-1572. 2. Niimi T, Natsume N, Tsukawaki T, Furukawa H, Masuda H, Kobayashi M and Kawai T (2000) Treatment of the nostrils in patients with cleft lip by a nostril retainer. British Journal of Oral and Maxillofacial Surgery 38(3):224-226. 3. Ozyazgan I and Eskitasçoglu T (2000) A new reshaped nostril retainer. Plastic and reconstructive surgery 105(2):804. 4. Matsuo K and Hirose T (1991) Preoperative non-surgical over-correction of cleft lip nasal deformity. Journal of Plastic, Reconstructive & Aesthetic Surgery 44(1):5-11. 5. Matsuo K, Hirose T, Otagiri T and Norose N (1989) Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period. Plast Reconstr Surg. 83(1):25-31.
Serap Titiz has completed her Graduation at Hacettepe University, Faculty of Dentistry in 2002; Postgraduation at Ege University, Faculty of Dentistry Department of Orthodontics and PhD in 2012. She was appointed as an Assistant Professor in Orthodontics at Usak University, Faculty of Dentistry since 2017.