Nasoalveolar Molding- Graysons Technique

Abstract

Since centuries neonatal maxillary orthopaedics is a treatment modality in which distorted and displaced maxillary segments at birth are repositioned by series oforthopaedic appliances to produce a normal appearing maxilla while reducing the cleft space in the alveolus and palate. Nasoalveolar molding got popularised because of its enabled nasal molding capability. Presurgical neonatal nasal remodeling with an infant plate was first described by Dogliotti et al. [1]. The first treatment protocol for nasoalveolar molding (NAM) was described and popularized by Grayson et al. [2]. This technique was different from the previous techniques of infant orthopedics where in a nasal stent was added to the intra oral plate enabling nasal and alveolar molding simultaneously. The combined oral plate and nasal stent produced a nasoalveolar molding appliance. The oral plate is used shortly after birth (approximately a week) and the nasal stent is added when the alveolar cleft is less than 0.5cm. The patient is usually treated with nasoalveolar molding therapy for 3 to 4 months until the alveolar cleft is less than 3mm and the nostril rim on the affected side had been repositioned. When the patient completes nasoalveolar molding therapy, primary lip, alveolar, and nasal surgery is performed.