The first modified presurgical orthopedic Naso-Alveolar Molding in IIUM: A joint effort between Neonatologist, Orthodontist and Plastic Surgeon

This case exemplifies a high level of compassion and sophistication through an interdisciplinary approach involving a neonatologist, orthodontists, and plastic surgeon, all collaborating towards a singular objective: the best interest of the patient.

Baby H was born in 2021 with a complete bilateral cleft lip and palate, a condition that occurs in approximately 1 in every 941 live births.

The challenges encountered in this case included addressing the complex emotions experienced by the parents upon receiving their child and managing the size and extent of the cleft.

Baby H was delivered at 38 weeks and 3 days of gestation. The cleft was diagnosed antenatally at 22 weeks’ gestation; however, the family did not fully comprehend the extent of the condition.

Due to the size of the cleft, which featured a prominent pre-maxilla, repair typically necessitates a staged approach, beginning with lip adhesion to reduce prominence, followed by definitive lip repair months later. Fortunately, the use of modified presurgical orthopedic naso-alveolar molding (NAM) allowed for the approximation of the separated segments, making a single-step definitive surgery feasible by reducing tension across the repair and shaping the nostrils. 

Unlike feeding plates, NAM, is a technique that utilizes an active appliance, to gradually bring the cleft segments closer together. It is a highly demanding treatment that requires a high level of skill, meticulous planning, constant review and patient compliance. This case report illustrates the use of NAM and how it increases quality of the lip repair outcome in this challenging case.