PRESURGICAL NASOALVEOLAR MOLDING IN AN INFANT WITH UNILATERAL CLEFT LIP AND PALATE: A CASE REPORT

Abstract

Presurgical nasoalveolar molding (NAM) is an established orthopedic technique used in the early management of infants with cleft lip and palate to reduce cleft severity and improve nasal symmetry prior to definitive surgical repair. This case report describes the management of a 20-day-old male infant presenting with a left-sided complete unilateral cleft lip and palate (Veau Group III). NAM therapy was initiated using a custom-fabricated intraoral molding plate, with regular appliance modifications to guide controlled approximation of the alveolar segments. Within one month of therapy, the alveolar cleft width was reduced from 12 mm to approximately 5 mm. During the second month, further approximation resulted in a cleft width of approximately 4 mm, following which a nasal stent was incorporated into the modified NAM appliance to facilitate molding of the columella and alar cartilages. By the third month, the infant weighed 4.9 kg and demonstrated continued improvement in nasal morphology. At the completion of five months of NAM therapy, the alveolar cleft width was reduced to approximately 1 mm, with marked improvement in nasal tip projection and alar symmetry. Following completion of presurgical molding, the patient underwent primary lip and nose repair with satisfactory esthetic and functional outcomes. This case highlights the effectiveness of early, staged NAM therapy in improving presurgical anatomy, facilitating surgical repair, and potentially reducing postoperative scarring and the need for secondary corrective procedures.