THE EFFECTIVENESS OF ACTIVE MODIFIED PRESURGICAL NASOALVEOLAR APPLIANCE IN ALIGNMENT OF PREMAXILLA OF COMPLETE BILATERAL CLEFT LIP AND PALATE INFANTS

INTRODUCTION: Complete bilateral cleft lip and palate CBCLP is considered the most difficult form of cleft cases nowadays. Nasoalveolar molding enhances the esthetic and functional results of cleft infants. NAM works on the principle of sculpting and molding of the alveolus and adjacent soft tissues.OBJECTIVES: The aim of this study was to assess the efficiency of a presurgical modified screw activated NAM appliance in retruding the premaxilla for CBCLP infants.MATERIALS AND METHODS: Fifteen CBCLP infant were included in the study. Preliminary maxillary impressions were made and the produced casts were scanned to obtain three-dimensional virtual image which was used to plan the design of the appliance. Two-piece acrylic active appliance with reverse expansion screw was used to retrude the premaxilla. The appliance was retained in place using niklel chromium side extension arms and head cap. When the cleft gap was closed to be suitable for surgical repair, primary lip repair was performed. Impressions were made again; the casts were scanned to be converted into 3D models on which linear analysis of the cleft gap was done.RESULTS: The results showed statistically significant decrease in the cleft gap following active alveolar molding.CONCLUSION: Active NAM appliance can effectively retrude and correct the severely rotated and deviated premaxilla providing better esthetic results.