Effectiveness of modified Naso alveolar moulding appliance on feeding and Naso alveolar moulding in unilateral cleft lip and palate babies

Cleft Lip and Palate is one of the most common craniofacial deformities occurring all over the world and has a higher ratio in India. Apart from serious problems like aspiration, infections, poor growth and development of the affected child, the family undergoes emotional struggles, postpartum depression of the new mothers, long term burden of care etc., Feeding the babies is one of the most important and immediate post-natal concern. Feeding plates, special bottles and nipples are available to facilitate feeding of cleft babies. Patients undergo many surgeries for correction of the cleft deformity from the age of 3 months. Reconstruction of the lips, palate and nose to normal anatomy is a challenge for surgeons. Presurgical Infant Orthopedics(PSO) was developed as an adjunct to the surgical management. Presurgical nasoalveolar moulding appliance (PNAM), a type of PSO was introduced by Grayson and Cutting, based on Matsuo’s cartilaginous moulding concept. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. The Primary goal of PNAM is to decrease the severity of the primary cleft deformity and provide symmetry to distorted nasal cartilage along with Nonsurgical lengthening of the columella. Approximation of lip segments and reduction of the cleft size decreases tension in the tissues during and after surgery reducing the severity of scarring. This produces a better surgical outcome of the lip repair and reduces the number of surgical revisions for nasal correction. Unlike other PSOs, NAM not only moulds the alveolar cartilage, but also the nasal cartilage, into near normal form and symmetry through a nasal stent.

These appliances generally facilitate feeding while reducing the cleft size. But, due to lack of complete oral seal, feeding especially breast feeding is still not completely effective with these babies. With the availability of newer materials like polyamide based denture materials, appliances can be made, to produce better intra oral suction facilitating easy feeding and more comfortability. This research on modified NAM appliance will not only improve alveolar and nasal moulding but also improve the baby’s overall growth and development with effective feeding while alleviating the apprehension of parents leading to a successful childhood.