Presurgical orthodontic treatment with ultraearly application of premaxilla-guiding nasoalveolar molding in feeding neonates

Background: The objective of this study was to present 3 cases of bilateral cleft lip and palate in which early application of premaxilla-guiding nasoalveolar molding (PG-NAM) achieved proper premaxillary alignment, columella, and upper lip lengthening by 2 months of age. Methods: Patients with bilateral cleft lip and palate were referred shortly after birth for intraoral scanning, which enables the creation of a 3-dimensional–printed jaw model. Using the jaw model, the Hotz plate was designed as a feeding plate. One week after birth, a nasal stent was applied to the Hotz plate. Once the stent was in place, 2 elastic lip tapes were used to prevent premaxillary collapse. Results: In all 3 cases, premaxillary alignment was completed within 1 through 2 months of appliance placement, and nasal septal curvature was observed after posterior premaxillary movement; however, at the time of palatoplasty, the nasal septum was straightened in all cases. Conclusions: These findings suggest ultraearly application of PG-NAM achieves appropriate premaxillary alignment, columella, and upper lip lengthening by 2 months of age, allowing for smooth surgical interventions.