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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : ZD04 - ZD07 Full Version

Correction of Unilateral Cleft Lip, Palate and Alveolus by Presurgical Nasoalveolar Molding using Modified Nasal Stent- A Case Report


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55193.16515
T Noufal, Shoaib Ulla Khan, B Goutham, Sunil Muddaiah, Sanju Somaiah

1. Postgraduate Student, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Virajpete, Karnataka, India. 2. Postgraduate Student, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Virajpete, Karnataka, India. 3. Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Virajpete, Karnataka, India. 4. Professor and Dean, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Virajpete, Karnataka, India. 5. Professor, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Virajpete, Karnataka, India.

Correspondence Address :
Shoaib Ulla Khan,
Postgraduate Student, Department of Orthodontics and Dentofacial Orthopaedics, Coorg Institute of Dental Sciences, Near Maguula Village, Kanjitanda Kushalappa Campus, Virajpete, Karnataka, India.
E-mail: drshoaibkhan.sk@gmail.com

Abstract

Cleft deformities may lead to psychological problems, dental problems, and aesthetic problems, if left untreated. Hence, the management of cleft patients is quite challenging and controversial which involves a multidisciplinary approach including members of various specialities. The Presurgical Nasoalveolar Molding (PNAM) method is an innovative therapy for mitigating the impact of craniofacial deformities. The use of PNAM therapy in a 2-day-old male infant is described in this case report. Impressions were taken during the first visit and on the same day lip tape therapy (lip taping) was started using 3M™ Steri Strip™. The Nasoalveolar Molding (NAM) plate was delivered to approximate the cleft alveolus. A modified nasal stent appliance was administered until the cleft gap was decreased to around 4 mm and the cleft lip was repaired through surgery. The use of PNAM with the modified nasal stent appliance showed promise in lowering the amount of the cleft deformity of the lip, palate, and alveolus, with improving nasal aesthetics. When comparing pre-NAM to post-NAM, there was also a considerable reduction in the alveolar defect. In cleft patients, the PNAM-assisted primary reconstruction employing a nasal stent appliance resulted in an overall improvement of the nasolabial complex, enhanced aesthetics, and a reduction in the extent of surgery and surgical operations.

Keywords

Lip taping, Nasolabial complex, Steri strip™

Case Report

A 2-day-old male infant (weighing 2.8 kg) reported to the Department of Orthodontics with the patient’s parents complaining of a cut on the lip and difficulty in feeding with mother having no history of any medications or injury during pregnancy.

The baby had a full solitary cleft lip, facial deformity, alveolus, and palate abnormalities on the left side; the cleft gap was 11 mm in size (Table/Fig 1)a,b. The case was evaluated, and it was decided to start the treatment with PNAM procedure. This procedure was chosen because it is the only method where the alveolar molding was done, and it minimises the extent of the intraoral alveolar cleft and the surrounding soft tissues impacted by the cleft. The parents were explained about the same along with the benefits and viable complications. Throughout the treatment, the need of parental support was emphasised. Parents were told about the placement of an intraoral acrylic plate, which would help the newborn achieve functional benefits such as improved feeding without nasal spillage.

Parents were also told about the drawbacks, which included intraoral lesions caused by rough spots on the tray and extraoral inflammation on the cheeks from improper tape detachment. After the explanation of the procedure and related complications, an intraoral primary maxillary impression with the help of modelling wax sheet dipped and softened in mild warm water was taken (Table/Fig 2). The initial cast was poured, and the secondary impression was made using a special tray made of clear acrylic resin.

Using Steri Strip™ (3M Steri StripTM) lip taping was done on the same day. Two distinct kinds of tapes were placed to the cheeks- base tape and a hydrocolloid type bandage that acted as a barrier between the holding tapes and the cheeks, reducing tissue irritation. Parents were instructed about lip taping that should be continued for a week (Table/Fig 3)a,b.

By using the custom tray with elastomeric material (Light body Regular set and Putty material, START KIT), the secondary impression was taken. The baby was in his mother’s lap with head facing downward, mother cradled the baby securely around the chest and torso, while the imprint was taken, support to the head and neck was provided. To avoid an obstruction of the airway, the newborn was made to wail while the imprint was taken. The excess impression material posterior to the tray was removed by finger motion, which would have also compromised the airway. Secondary impressions were poured with orthokal stone and two casts were procured, one as a working model and second for study model. Modelling wax was used to cover the alveolar gap and any other undercut spots on the physical model (Table/Fig 4)a, and an auto-polymerising transparent acrylic resin plate (DPI-RR Cold Cure, Acrylic repair material), of at least 2 mm thickness was created (Table/Fig 4)b.

In some older techniques by Grayson BH and Cutting CB, traditional NAM pushes or stretches the delicate tissues, to overcome this we followed the modified NAM technique (1) with an active palatal plate (gently directs alveolar growth). The palatal plate trail was performed, the proper fit and any rough surfaces were checked and smoothened. To hold the intraoral plate, a retentive button was then added in the centre of the NAM plate. Extraoral rubber tape provides support for this retentive button (Table/Fig 4)c,d.

The real molding plate was put into the baby's mouth in the next appointment. To make sure the proper fit and retention of molding plate, red orthodontic elastics of 0.25 inch diameter were used on to the handle of the NAM plate. Later, Steri Strips™ were extended and attached to the base tapes on the infant’s cheeks (Table/Fig 4)c,d.

The above-mentioned linkages established a great backward and superior retentive force. To keep the plate in place, Steri Strip™ and red elastics were changed once daily. A modified nasal stent was administered after two and a half months, when the cleft gap was decreased roughly to 4 mm from 11 mm, to improve retention. This appliance was a modification to the conventional nasal stent attachment, which is less bulky and has a projection of acrylic material, supported by round stainless-steel wire which was attached to the forehead (Table/Fig 5)a,b. This appliance included a nasal stent that was covered in a soft reliner, while taking support from the forehead and put passively into the nose, as well as Steri Strip™ provided support from the forehead. The phase of active nasal cartilage molding was started which was achieved by lifting the collapsed side of the nostril with the modified nasal stent appliance (Table/Fig 5)c,d.

The infant’s weight increased from 2.5 kg to 5 kg by using NAM plate over the course of treatment. After the completion of the NAM procedure, the authors noticed the difference in the alveolar cleft- the length of columella was increased, the nasal cartilage symmetry was improved and collapsed nostril was directed to normal (Table/Fig 6)a,b,c,d,e.

Three months after initiation of PNAM, Oral and Maxillofacial surgeon and Orthodontist evaluated the position of lips, alveolus, and nasal area. (Table/Fig 7)a,b and c shows the pictures taken at the time of surgery. After the procedure, the modified nasal stent appliance was discarded, following improvement in the cleft lip (Table/Fig 8)a,b.

Discussion

Cleft deformities may lead to psychological problems, dental problems and aesthetic problems if left untreated. Hence, the management of cleft patients is quite challenging and controversial which involves multidisciplinary approach including members of various specialities (1).

In the treatment of patients with cleft palate, Grayson BH et al., invented the notion of nasoalveolar molding, which coupled a nasal molding stent with a passive preoperative molding equipment (2). The labial tapes have been used to approximate alveolar gap with acrylic plate. Nasal stents aid in the molding of nasal cartilage and improves nasal symmetry. For retention, two elastic face tapes were utilised. The most common negative effects of NAM therapy, according to Grayson, are soft-tissue irritation and ulceration (2). By sculpting the bony segments, PNAM minimises the extent of the intraoral alveolar cleft and the surrounding soft tissues impacted by the cleft (3),(4). A nasal stent, which enters the nasal aperture from the labial flange of a standard oral molding, was used to achieve this, on the other hand modified nasal stent appliance took support from the forehead. The modified nasal stent gives better comfort than conventional method and retention of Presurgical Infant Orthopaedic (PSIO) appliance is not disturbed (5).

Grayson BH and Cutting CB described an alveolar molding process that has been refined multiple times (1). Parents co-operation and adequate compliance is required during the PNAM procedure. PNAM procedure should begin as early as possible because after two months of life the infant’s cartilages begins to dwindle and reduce its plasticity (6). NAM plate helps to reduce the level of deformity, deviation, and dislocation of the damaged structures before surgery (7).

Misdirected molding, nose over expansion, and exposure of the primary tooth bud are few of the drawbacks of NAM (8). A hole in the centre of the NAM plate is added to lessen the effect of airway 6blockage caused by dislodgement of the NAM appliance. Failure of the moulded nasal cartilages were around after one year of age. Some relapses of the nostril form in breadth (10%), height (20%), and columella angle (4.7%) were reported (8). Conventional nasal stent has a disadvantage, such as reciprocal molding force against the alveolar segment was removed by using NAM plate and modified nasal stent appliance (9). NAM plate is less bulky than the conventional appliance and enhances the retention of molding plate. In cleft cases, the PNAM assisted primary reconstruction by adopting the above-mentioned appliance resulted in an overall improvement of the nasolabial complex (9).

In this case report, modified nasal stent appliance was used with NAM plate which is easy to fabricate and use to achieve near to normal anatomy of alveolus and lip before surgery (9). Because the nasal stent and NAM plate are independent of one another, this appliance enhances retention and helps to avoid the unwanted intraoral reciprocal molding force that obstructs alveolus fusion (9). During the surgical procedure of lip, the tension was minimal due to the use of presurgical lip taping.

Titiz S and Aras A in their recent article used a stent on the non cleft nostril that accelerates the nasal molding process by taking advantage of the plasticity of the tissues (10). The modified Figueroa NAM technique is a good alternative to the standard Figueroa NAM approach since it makes appliance adjustment easier during follow-up (11). Jodeh DS et al., employed the addition of orthodontic buttons to the Latham Dentomaxillary Appliance (DMA) in place of a screw mechanism which drastically reduces the amount of time required to approximate the cleft segments (12). The main benefit of employing a modified nasal stent appliance is that it eliminates the disadvantage of using a traditional nasal stent where the alveolar segments are shaped by a bilateral intraoral molding force.

Conclusion

Presurgical Nasoalveolar Molding using modified nasal stent gave a promising result by reducing the extent of the cleft deformity of lip, palate, alveolus and improving the nasal aesthetics. Prior to surgery, PNAM proved to be a useful supplementary therapy in minimising the cleft deformity from 11 mm to 4 mm. Aesthetics were enhanced and the number of surgical treatments was whittled down. There were added psychological benefits, satisfaction with facial appearance was also improved prior to primary surgical lip repair.

References

1.
Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate-Craniofac J. 2001;38(3):193-98. [crossref] [PubMed]
2.
Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36(6):486-98. Doi: 10.1597/1545-1569_1999_036_0486. 2.3.CO;2>[crossref]
3.
Mathew A, Muddaiah S, Subrahmanya JB, Somaiah S, Shetty B, Reddy G. Presurgical nasoalveolar molding in a 4-day-old infant with unilateral cleft lip, alveolus, and palate deformity. APOS Trends Orthod. 2018;8(4):225-29. [crossref]
4.
Barillas I, Dec W, Warren SM, Cutting CB, Grayson BH. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients. Plast Reconstr Surg. 2009;123(3):1002-06. [crossref] [PubMed]
5.
Jolly J, Reddy G, Muddaiah S, Somaiah S, Shetty B, Roopa S. Presurgical nasoalveolar molding assisted primary reconstruction in 5-day old infant with unilateral cleft lip, alveolus and palate using PSIO-J hook appliance a case report. Int J Adv Res. 2019;7(4):339-47. [crossref]
6.
Mishra B, Singh AK, Zaidi J, Singh GK, Agrawal R, Kumar V. Presurgical nasoalveolar molding for correction of cleft lip nasal deformity: Experience from northern India. Eplasty [Internet]. 2010;10:443-57.
7.
Premkumar S, Kunthavai CR, Tovani-Palone MR. Clinical application of customized presurgical nasoalveolar molding for the treatment of unilateral complete cleft lip and alveolus: Case report. Electron J Gen Med. 2018;15(5):em76. [crossref]
8.
Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac J. 2005;42(6):658-63. Doi: 10.1597/04-126.1. [crossref] [PubMed]
9.
Kornbluth M, Campbell RE, Daskalogiannakis J, Ross EJ, Glick PH, Russell KA, et al. Active presurgical infant orthopedics for unilateral cleft lip and palate: Intercenter outcome comparison of Latham, modified McNeil, and nasoalveolar molding. Cleft Palate-Craniofac J. 2018;55(5):648-49. [crossref] [PubMed]
10.
Titiz S, Aras A. Presurgical orthopedic treatment using modified nostril retainers in patients with unilateral cleft lip with or without cleft palate. J Craniofac Surg. 2017;28(6):1570-72. [crossref] [PubMed]
11.
Chen YF, Liao YF. A modified nasoalveolar molding technique for correction of unilateral cleft nose deformity. J Cranio-Maxillofac Surg [Internet]. 2015;43(10):2100-5. Available from: http://dx.doi.org/10.1016/j.jcms.2015.10.003. [crossref] [PubMed]
12.
Jodeh DS, Ruso S, Feldman R, Ruas E, Rottgers SA. Clinical outcomes utilizing a “Modified Latham” appliance for presurgical infant orthopedics in patients with unilateral complete cleft lip and palate. Cleft Palate-Craniofac J. 2019;56(7):929-35. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55193.16515

Date of Submission: Jan 25, 2022
Date of Peer Review: Feb 24, 2022
Date of Acceptance: Apr 12, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 28, 2022
• Manual Googling: Apr 04, 2022
• iThenticate Software: May 30, 2022 (9%)

ETYMOLOGY: Author Origin

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