FROM DEFORMITY TO SYMMETRY: A CASE REPORT ON PRESURGICAL NASOALVEOLAR MOULDING IN BILATERAL CLEFT REHABILITATION

Bilateral cleft lip and palate presents with complex three-dimensional deformities involving the alveolar segments, nasal cartilage, and lip, posing significant challenges for primary surgical repair. Presurgical Naso alveolar moulding (NAM) is a non-surgical orthopaedic technique that aims to reduce the severity of the cleft deformity by approximating the alveolar segments and moulding the nasal cartilages before surgical intervention. A newborn with a bilateral complete cleft lip and palate was referred for presurgical orthopaedic management. Clinical examination revealed a wide alveolar cleft with protrusion of the premaxillary segment and significant bilateral nasal deformity. A customized NAM appliance was fabricated such that the premaxillary segment and palatal segment of the plate were constructed as a separate unit only attached by 0.5mm stainless steel wire which could be activated to reposition the severely deviated premaxilla to the midlineand also approximate the alveolar segments, and improve nasal symmetry. Progressive adjustments resulted in reduction of the alveolar cleft width,improved positioning of the premaxillary segment, elevation and moulding of the nasal cartilages, and enhanced columellar length. The improved presurgical morphology facilitated approximation of the lip and nasal tissues during subsequent surgical repair.