Three-dimensional assessment of nasolabial area in patients with unilateral cleft lip and palate following different pre-surgical orthopedic treatment: case series

BACKGROUND: Presurgical infant orthopedic therapy was introduced by McNeil in 1956 in order to facilitate patients’ feeding ando to provide stimulation and guidance of maxillary segments’ growth as well as to facilitate surgical management of cleft lip and palate patients. To quantify soft-tissue labial changes in patients treated different orthopedic appliances for the correction of unilateral complete cleft lip and palate (UCCLP) a new three-dimensional (3D) software (3dMD, Atlanta,Ge) was employed. Previous studies have used this new technology to investigate the growth rate and the effectiveness of orthopedic equipment in patients affected by UCCLP. The aim of the study is to evaluate three dimensional subsequent changes to nasolabial area following different orthopedic procedures in the treatment of patients with UCCLP. METHODS: Three male patients with congenital non-syndromic unilateral complete cleft lip and palate (III Veau class) on the left side are presented in this report. The study reports the results achieved at the last month of the therapy. As described in the putty-wash technique, maxillary impressions covering the critical areas of the alveolar ridge and palate cleft were taken in two stages using putty-dough and light-bodied fast setting polyvinyl siloxane (PVs) impression materials with a light-cured resin custom-made impression tray. ADA Type III plaster casts were poured. All the orthopedic devices were fabricated by the same laboratory technician. In patient A, the stone cast was duplicated and then discarded 1 mm in the midsagittal plane before plate realization in order to reduce the transversal discrepancy between maxillary segments prior to surgery. The cast replica was used to realize a custom tray. In patient B, after alveolar segments had achieved a proper alignment, clinicians decided to realize a final passive plate in order to avoid recurrence. According with the Cutting-Grayson technique, in patient C a nasal stent was applied with the aim of moulding nasal cartilage and improving the length of the columella, thus facilitating surgical intervention. Three-dimensional photographs were obtained using the 3dMD system (3dMD, Inc, Atlanta, GA) 1 month before the try-in and delivery of the orthopedic appliance and 1 month later.All measurements were carried out blindly to the patient group.The authors assessed the qualitative and quantitative changes in asymmetry using the 3dMDtrio System and 3dMD patient software. RESULTS: Individuals with active device showed a reduction in cleft and an improvement of symmetry, the subject with passive orthopedic appliance showed no changes in the analyzed parameters. CONCLUSIONS: The use of new 3D technologies allows clinicians to study very accurately the growth and the effects of treatment in newborns with malformation problems. The analysis of these three cases of UCCLP confirms that the treatment with presurgical infant orthopedic therapy is effective in restoring the symmetry of the face. The difference between active and passive devices also suggests the need to evaluate their ability of improving nasoalveolar simmetry in long-term studies.