Presurgical Nasolaveolar Molding for Infant with Labiognathopalatoschizis Bilateral Complete

Abstract

Introduction: Cleft lip and palate (labiognatopalatoschizis) is a common congenital defect on craniofacial anomaly, arises with considerable variation in severity and form. It caused by internal (genetic) or external factors (environmental). Case report: This case report presented a sixteen days infant with 2.3 kg weight who had bilateral cleft lip and palate. The prolabium and columella were fused without a philtrum. The premaxilla rotates lateroanterior that covers the left nostril. The width of the alar base was significantly increased, and the lip segment far apart. This patient experienced difficulty in breastfeeding and will be treated with presurgical nasoalveolar molding (PNAM) with extra oral strapping. Anatomical sections of the anterior premaxilla were adjusted at each visit and installation of extra oral strapping to direct the premaxillary segment towards the median. After used PNAM, the baby had good sucking reflex and easy to breastfeed. After five months of treatment the position of the premaxilla has begun to recede and is slightly more to the median, the width of the defect getting smaller. The baby has met the "rule of ten" criteria and referred to the surgical department to undergo labioplasty surgery. Discussion: The PNAM design used was a hotz and Kogo modification. It’s a combination of the Hotz plate that covers the alveolar segment and then extends posteriorly to the uvula combined with the Kogo design with a 2 mm elevation on the posterior plate which acts as a close box. When a reduction in the width of the alveolar cleft is achieved, the nose floor and lip segments achieve better alignment. The PNAM installation also functions as a drinking aid so that the baby does not choke and can get good nutrition. Conclusion: Installation of PNAM will make it easier for surgical operators to perform repositioning and reconstruction properly.