J Clinical Pediatric Dentistry. 2017; 41(6):442-445. doi: 10.17796/1053-4628-41.6.4. Epub 2017 Sep 22.
The specific aim of this retrospective cross-sectional study was to assess the efficacy of DynaCleft® as a method of pre-surgical orthopedics with infants with a unilateral cleft lip and cleft palate who used an oral obturator.
Data was collected from 25 infants all of comparable age diagnosed with a unilateral complete cleft lip and palate. Eight patients used DynaCleft ® and an obturator (Group Alpha) and seventeen patients only had an obturator (Group Beta). Maxillary impression casts were obtained from each patient at the initial clinic visit and at the time of cleft lip repair. Differences in alveolar cleft width were compared between the two groups. Casts were measured twice by one observer using a digital caliper.
Group Alpha began treatment on an average age of 24.25 days and Group Beta an average of 15.35 days of age. The average cleft width of Group Alpha was 8.13 mm and after treatment it was 4.59 mm. The average cleft width of Group Beta was 8.09 mm and 6.92 mm after treatment. Results of paired t-tests and two-sample t-test showed that cleft width changes between the two groups were significant (P = .03).
DynaCleft ® significantly decreased the size of the alveolar cleft width compared to infants who did not use it. Providers should consider using DynaCleft® for patients who may not have access to infant maxillary orthopedics.
The nasal alar elevator: a new device that may reduce the need for primary operation of the nose in patients with cleft lip.
Abdiu A1, Ohannessian P, Berggren A.
Scand J Plast Reconstr Surg Hand Surg. 2009;43(2):71-4.
To improve the shape of the cleft lip nose preoperatively, we have developed the nasal alar elevator. This has been used routinely since 1996 on all our cleft lip patients who have an asymmetrical nose, from the first week after birth until the date of primary lip surgery. We present our 11-year-long experience of using the device on patients born with complete, unilateral cleft lip. In this study 56 children, born between 1996 and 2006 inclusive, with complete unilateral cleft lip, had preoperative treatment with the elevator. During this 11-year period, continuous evaluation during the preoperative period, and its effects on the cleft lip nose, were evaluated, both preoperatively and postoperatively. Our results show that the preoperative use of the device has led to less need for primary nasal surgery. Instead of having to have a primary rhinoplasty (McComb) together with a lip plasty, as a routine, now only about 30% of the patients need primary surgical correction of the nose. If nasal correction is needed, a rather limited undermining of skin over the ala on the cleft side will often be sufficient. The use of a nasal elevator reduces both the length and the extent of the primary intervention, without compromising the final result.
The nasal alar elevator: an effective tool in the presurgical treatment of infants born with cleft lip.
Berggren A, Abdiu A, Marcusson A, Paulin G.
Plast Reconstr Surg. 2005 May;115(6):1785-7.
(no abstract – letter to editor)
Comparative study of nasoalveolar molding methods: nasal elevator plus DynaCleft® versus NAM-Grayson in patients with complete unilateral cleft lip and palate.
Monasterio L, Ford A, Gutiérrez C, Tastets ME, García J.
Cleft Palate Craniofac J. 2013 Sep;50(5):548-54.
To compare nasoalveolar molding (NAM) effect employing a nasal elevator plus DynaCleft® and NAM-Grayson system in patients with complete unilateral cleft lipand palate.
Prospective study in two groups. Group A included 20 consecutive patients treated with DynaCleft® and a nasal elevator before lip surgery. Group B included 20 patients treated with NAM-Grayson system. Maxillary casts and standard view photographs were done before and after treatment. Columella deviation angle, soft tissue distance of the cleft, intercommisural distance, and nostril height and width were traced and measured on the printed photos; a ratio was obtained and compared before and after treatment. Cleft width, anterior width, and anteroposterior distances were measured on the maxillary cast.
Group A began treatment at an average age of 14.3 days and group B at an average age of 16.9 days; no complications were observed. For group A, the initial average alveolar cleft within the cast was 10.7 mm, and after treatment it was 6.6 mm. For group B, pre-treatment width was 11.2 mm, and after treatment it was 5.9 mm. No differences were found on the anterior and posterior width, and A-P distance of both groups. The initial mean columellar angle in group A was 38.1°, and after treatment it was 61.5°; for group B the initial mean columellar angle was 33.6°, and after treatment it was 59.5°. Results of Mann-Whitney U and Student’s t tests showed no differences (P > .05). Width and height dimensions of the nostril showed minor differences.
Both methods significantly reduced the cleft width and improved the nasal asymmetry. Our findings show that both methods produced similar results