Presurgical nasoalveolar molding in cleft patients
Suri S, Disthaporn S, Atenafu EG, Fisher DM. Presurgical presentation of columellar features, nostril anatomy, and alveolar alignment in bilateral cleft lip and palate after infant orthopedics with and without nasoalveolar molding. Cleft Palate Craniofac J 2012;49:314-24
Achieving an esthetic outcome from surgical procedures in cleft patients is a common concern for all treating clinicians, parents, and patients. Many cleft teams include presurgical infant orthopedics in their treatment protocols before initial lip repair. Infant orthopedics is described in this article as an oral plate with lip taping with or without nasoalveolar molding. Nasoalveolar molding is becoming more popular with these teams that include infant orthopedics, although it remains controversial. The aim of this retrospective study was to quantitatively analyze, in infants with bilateral cleft lip or palate, the presurgical nasal anatomy and the alveolar alignment after orthopedic treatment. The authors also wanted to explore the possible relationships among presurgical anatomy, length of treatment time before lip surgery, age at lip repair, and age at which treatment started. Data were collected on 29 patients (51 nostrils) treated with nasoalveolar molding and 17 patients (29 nostrils) treated with infant orthopedics only. Each nostril was analyzed and calculated individually. Nostrils with Simonart’s bands were excluded. One surgeon made all measurements immediately before lip repair while the patient was under general anesthesia. Orthopedic treatment had been conducted by several orthodontists. The analysis showed that the group treated with nasoalveolar molding had decreased alveolar irregularity, a longer and narrower columella, an increased columellar length-to-width ratio, and a decreased columellar angle. The age at which the patients were started with presurgical infant orthopedics, lip repair, and treatment time differences was not statistically significant. The authors concluded that more favorable presurgical alveolar and columellar presentations were seen with nasoalveolar molding than with infant orthopedics alone; however, they also suggested that further research is warranted.
Reviewed by Kevin Toms
Head alignment and distortion of panoramic radiographs
Sadat-Khonsari R, Fenske C, Behfar L, Bauss O. Panoramic radiography: effects of head alignment on the vertical dimension of the mandibular ramus and condyle region. Eur J Orthod 2012;34:164-9
Panoramic radiographs are a common diagnostic tool used by orthodontists. These radiographs are helpful in visualizing pathology, periodontal health, root positions, impactions, bone morphology, and other abnormalities. These authors examined the reliability of using the panoramic radiograph for diagnosing ramal and condylar asymmetries. A dry human skull was mounted on a cephalostat in a panoramic machine and purposefully displaced along the sagittal, transverse, and vertical planes or axes. The authors obtained 252 radiographs with defined positioning simulated errors and compared them with a set of 42 ideally positioned panoramic radiographs. Translating the skull along the sagittal and transverse (y-axis) planes did not result in significant distortion of the condyle or ramus region. However, simultaneous rotation of the skull around the cranio-caudal z-axis and the transverse y-axis to the same side resulted in significant magnification errors. The greatest distortion was due to shifting the head along the transverse and cranio-caudal axes concomitantly. Despite these simulated errors in positioning, dimensional differences were statistically significant but clinically small. The authors concluded that asymmetries of more than 6% between the vertical dimensions of the right and left condyles and rami might be due to true asymmetries and not to operator error. Proper positioning of the patient in the panoramic machine is vital for proper diagnosis and treatment planning.
Reviewed by Jay S. Garrel