CE ARTICLE

THE FOCUS IS PLEASED TO PRESENT TWO CE ARTICLES ON FOLLOWING PAGES. This new endeavor, which we hope to offer each issue, provides members the opportunity to read about a variety of topics related to the practice of dentistry. In addition, after reading the section, members will be able to take a CE quiz for credit. So to, if members feel inclined, they may submit articles and case studies for publication upon review and approval by the editorial committee. The goal of this section is to bring more clinical articles into the Focus and highlight the achievements and clinical accomplishments of some of our members.

A better alternative for cleft lip and palate children

by TARA CASH, DDS, MS

quality of repairs, the surgery by itself does not correct all aspects of the defect.

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In the standard repair of the lip, columella, and philtrum, the amount of scarring that occurs is severe. When the standard repair is completed, multiple additional surger- ies are required to correct and improve the initial surgery repairs. In any case of cleft lip and palate, the goal is to repair the tissues to normal anatomy.

The Institute of Reconstructive Plastic Sur- gery At New York University Medical Center developed a new approach of pre-surgical nasoalveolar molding technique. This tech- nique will be described in this article, and the results are an overall improvement in appear- ance of the nasolabial complex while allow- ing the patient to undergo fewer surgeries.

True benefits to both the patient and family can be seen through the use of a Nasoalvelor Molding Appliance (NAM). This appliance lengthens the columella and can reduce childhood surgeries from 18 to 20, down to 1 to 2, thus furthering science and arguments that the use of the NAM appliance offers long-term benefits.

ETIOLOGY

A fetus’ face forms during gestational weeks five through eight. If there is a failure in tissue formation and cell migration, a cleft lip or palate is possible. The most common

hile advances in techniques of repairing cleft lip and plate deformities have significantly improved the

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Figure 1) Pre-treatment; Figure 2) NAM placed; Figure 3) Pre-surgery; Figure 4) Post-surgery; Figure 5) Few months post surgery; Figure 6) NAM appliance

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cleft is the unilateral cleft. It occurs mostly in males and on the left side.

There are several variations of the cleft lip and palate that occur. Many factors can contribute to the development of a cleft palate or lip. Some research suggests genetic tendency or an association with certain syndromes, such as Stickler syndrome, van der Woude syndrome, hemifacial microsomia and Treacher Collins syndrome. In addition, there are environmental factors that may contribute, including drug use, alcohol inges- tion, certain medications and nutritional de- ficiencies during the first trimester. However, because no absolute cause has been identi-

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fied, once a cleft lip or palate has formed, treatment then becomes the critical issue for families. This is when the NAM appliance should be immediately considered.

PROCEDURE PROTOCOL

The infant’s first exam generally occurs at seven days of age, when a mold of the infant’s palatal shelves and pre-maxilla is taken in the dental office. The orthodontist then makes a stone cast of the alveolar segments and premaxilla and fabricates the appliance. After the initial visit, the NAM is placed at 10 to 14 days post birth.