NASO ALVEOLAR MOLDING BY TRADITIONAL GRAYSONS TECHNIQUE AND A MODIFIED TECHNIQUE INVOLVING REDUCED PATIENT VISITS-TWO CASE REPORTS

Cleft lip and palate are congenital deformities affecting approximately 1 in 500-700 births. Their management requires a multidisciplinary team, including paediatricians, paediatric dentists, orthodontists, craniofacial and plastic surgeons, and speech therapists. Presurgical nasoalveolar moulding (PNAM), typically initiated by a paediatric dentist, uses an oral moulding plate with a nasal stent to reduce the alveolar cleft gap, reshape the nasal cartilage and alveolus, improve nasal alignment before primary lip closure, support feeding, and reduce nasal regurgitation. This report describes two infants with complete unilateral cleft lip and palate treated using either the traditional Grayson technique or a modified technique advocated by the Nitte Meenakshi Institute of Craniofacial Surgery, Nitte University. After three months, both techniques reduced the alveolar cleft gap, decreased the width of the affected nasal dome, and increased its height, producing a more normal nostril contour. The modified technique reduced the need for weekly hospital or cleft-centre visits; follow-up every two to three weeks was sufficient. PNAM is therefore an important component of cleft care because it reduces deformity and postoperative scarring, may limit the need for later scar-revision surgery, and facilitates gingivoperiosteoplasty by approximating the alveolar segments.