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OP-015 Presurgical nasolveolar remodeling and bone-supported maxillofacial orthopaedics in cleft lip and palate: a multistage journey from newborn to adolescence
  1. Emre Kayalar1,
  2. Amir Heydari2,
  3. Esra Genc2,
  4. Ahmet Karaman2,
  5. Elif Erbay3
  1. 1The University of Sydney
  2. 2Istanbul Aydin University
  3. 3Istanbul University


Aim This case report presents a comprehensive treatment approach for cleft lip and palate, incorporating presurgical nasoalveolar remodeling (PNAM) followed by mini-implant supported maxillofacial orthopaedics. The study details the journey of a male patient born on March 21, 2011, with the treatment concluding on January 4, 2024, emphasising the significance of pre-surgical interventions in optimising facial growth. The patient underwent a structured treatment protocol from newborn to adolescence, initiating with presurgical nasoalveolar remodeling and progressing to mini-implant supported maxillofacial orthopaedics.

Material and Method The treatment approach involved a systematic PNAM protocol followed by bone-supported maxillofacial orthopaedic interventions. PNAM was initiated early in the neonatal period to address nasal and alveolar deficiencies before surgical correction. Subsequently, mini-implant supported maxillary expansion and maxillofacial protraction using a mini-implant supported Facemask were implemented to address maxillary arch discrepancies and promote favourable midfacial growth. Dental alignment was deliberately deferred during this phase to prioritise skeletal corrections.

Results The multistage treatment approach successfully addressed nasal and alveolar deformities pre-surgically, providing a foundation for subsequent maxillofacial orthopaedics. Mini-implant supported techniques contributed to favourable skeletal changes, enhancing midfacial projection. The intentional delay in dental alignment allowed for the establishment of a stable skeletal foundation for future orthodontic interventions. Through a combination of PNAM protocol, surgical interventions and bone-supported maxillofacial orthopaedics, the patient achieved improved facial symmetry, normalised oral function. Long-term follow-up demonstrated the stability of results and enhanced psychosocial well-being.

Conclusions This case report underscores the effectiveness of integrating presurgical nasoalveolar remodeling with mini-implant supported maxillofacial orthopeadics in the comprehensive management of cleft lip and palate patients. By emphasizing presurgical interventions and strategically deferring dental alignment, this approach aims to optimize skeletal corrections and lay the groundwork for subsequent orthodontic phases. Sharing our experience aims to contribute valuable insights to the evolving field of cleft lip and palate management from newborn to adolescence.

  • Cleft Lip and Palate
  • CLP
  • Presurgical Nasoalveolar Molding
  • PNAM
  • Maxillary expansion and protraction

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