Our Summary

Orthodontists often use a technique called presurgical infant orthopedics (PSIO) when treating patients with cleft lip and palate (CLP), a common birth defect where a baby’s lip or mouth do not form correctly during pregnancy. This method is seen as a way to improve the results of surgery with minimal intervention. However, the effects of PSIO can be influenced by the type and timing of the surgery, making it hard to measure the exact impact of the treatment.

One common PSIO method is nasoalveolar molding (NAM). This treatment has advantages and disadvantages. Some negatives include a higher cost, more care required, and potential negative effects on the growth of the upper jaw. However, previous research shows that NAM doesn’t seem to have long-term positive or negative effects on the growth of the face or soft tissues.

When compared with patients who did not receive PSIO, NAM does not alter the growth of the face. Despite this, studies show that NAM has several benefits for patients, caregivers, surgeons, and society. These benefits include a reduction in the severity of the cleft deformity before surgery, improved surgical outcomes, reduced need for additional surgeries, and lower overall cost of care.

FAQs

  1. What is presurgical infant orthopedics (PSIO) and when is it used by orthodontists?
  2. What are the advantages and disadvantages of the nasoalveolar molding (NAM) method?
  3. How does NAM impact the growth of the face and what are its benefits?

Doctor’s Tip

Overall, it is important for patients to discuss the potential benefits and risks of PSIO with their healthcare provider before deciding on a treatment plan for craniofacial surgery. It is also important for patients to follow their doctor’s recommendations for post-surgery care to ensure optimal results.

Suitable For

Patients who are typically recommended for craniofacial surgery include those with cleft lip and palate, craniosynostosis (premature fusion of the skull bones), craniofacial microsomia (underdevelopment of the face and skull), hemifacial microsomia (underdevelopment of one side of the face), facial trauma, facial tumors, and other congenital or acquired deformities of the face and skull. These patients may experience functional issues such as difficulty breathing, eating, speaking, or hearing, as well as aesthetic concerns that can affect their self-esteem and quality of life. Craniofacial surgery aims to improve both the function and appearance of the face and skull, often through a combination of reconstructive, cosmetic, and orthodontic procedures.

Timeline

Before craniofacial surgery, a patient with cleft lip and palate may undergo presurgical infant orthopedics, such as nasoalveolar molding, to improve the results of surgery. This treatment involves molding the soft tissues and bones of the face to reduce the severity of the cleft deformity. The patient and caregivers will need to provide extra care and attention during this time.

After craniofacial surgery, the patient may experience improved surgical outcomes, reduced need for additional surgeries, and a lower overall cost of care. The effects of presurgical infant orthopedics, such as nasoalveolar molding, on the growth of the face and soft tissues are minimal and do not seem to have long-term positive or negative effects. Overall, the benefits of presurgical infant orthopedics outweigh the potential drawbacks for patients with cleft lip and palate.

What to Ask Your Doctor

  1. What specific type of craniofacial surgery do I need for my condition?
  2. How will presurgical infant orthopedics (PSIO), particularly nasoalveolar molding (NAM), impact my treatment plan?
  3. What are the potential advantages and disadvantages of undergoing PSIO/NAM treatment before my surgery?
  4. Are there any potential risks or complications associated with PSIO/NAM that I should be aware of?
  5. How will PSIO/NAM affect the overall outcome and success of my craniofacial surgery?
  6. Will PSIO/NAM require additional care or maintenance during treatment?
  7. How will PSIO/NAM impact the growth and development of my face and jaw in the long term?
  8. Are there any alternative treatment options to PSIO/NAM that I should consider?
  9. Can you provide me with information on the research or studies supporting the use of PSIO/NAM in craniofacial surgery?
  10. What can I expect in terms of cost and insurance coverage for PSIO/NAM treatment in conjunction with my craniofacial surgery?

Reference

Authors: Esenlik E, Gibson T, Kassam S, Sato Y, Garfinkle J, Figueroa AA, AlQatami F, Runyan C, Alperovich M, Golinko MS, Lee C, Chatzigianni A, Zafeiriadis AA, Santiago P, Hosseinian B, Kaygısız EU, Üçüncü N, Aslan BI, Uzuner FD, Gülşen A, Akkurt A, Arslan SG, Sabás M, Muñoz-Mendoza MA, Masis D, Holguin L, Granados A, Rojas NE, Campo B, Keskin K, Akçam MO, Lowe KM, Morselli PG, Pannuto L, Yarza IN, Martinez AT, Coşkun EY, Nissan S. Journal: Cleft Palate Craniofac J. 2020 Apr;57(4):529-531. doi: 10.1177/1055665619899752. Epub 2020 Jan 21. PMID: 31960709