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Airway obstruction exacerbated by Naso-alveolar Molding in unique cleft anatomy: Pre-Surgical Infant Orthopedics modification recommendations
Aaron M. Foglio, Jonathan Y. Lee, Lindsay Schuster, Alexander Davit, Jesse A. Goldstein, Joseph E. Losee
University of Pittsburgh School of Medicine
2018-02-14
Presenter: Aaron M. Foglio
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION: A series of patients sharing a unilateral cleft morphology associated with nasal airway obstruction is presented. Nasoalveolar molding (NAM) exacerbates this obstruction. Lip-Nose Adhesion (LNA) is the recommended course of therapy.
CASE REPORTS: Four patients presented to the cleft-craniofacial center with a cleft morphology in which NAM exacerbated airway obstruction. The morphology is characterized by bilateral nasal airway constriction. The greater alveolar segment is overly projected anteriorly, with collapse of the lesser segment posteriorly. The cleft alar base is therefore displaced posteromedial to the anteriorly projected greater segment. This results in the cleft ala being draped over the leading edge of the greater segment, obstructing the cleft side nostril. The caudal septum is displaced into the non-cleft nostril, secondary to attachments to the orbicularis oris from the non-cleft side. This results in a bilateral nasal airway obstruction that is exacerbated by NAM and lip taping.
NAM was attempted in the first presenting patient with failure due to breathing difficulties. These patients underwent LNA. LNA releases the tethered cleft side alar base from the pyriform rim of the posteromedially collapsed minor segment and unites the superior lip and nostril sill - relieving the cleft side nostril obstruction. The caudal septum is released from the anterior nasal spine and is uprighted, relieving the obstructed non-cleft nostril. Airway obstruction was immediately relieved after LNA.
CONCLUSION: In patients with the described unique anatomic variant, NAM exacerbates airway obstruction and should be replaced by LA as an effective mode of PSIO.
