The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft.

The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.

Accuracy and reliability of craniometric measurements on lateral cephalometry and 3D measurements on CBCT scans.

OBJECTIVE: To compare the accuracy of craniometric measurements made on lateral cephalograms and on cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: Ten fiducial markers were placed on known craniometric landmarks of 25 dry skulls with stable occlusions. CBCT scans and conventional lateral headfilms subsequently were taken of each skull. Direct craniometric measurements were compared with CBCT measurements and with cephalometric measurements using repeated measures analysis of variance (ANOVA). All measurements were repeated within a 1-month interval, and intraclass correlations were calculated. RESULTS: No statistically significant difference was noted between CBCT measurements and direct craniometric measurements (mean difference, 0.1 mm). All cephalometric measurements were significantly different statistically from direct craniometric measurements (mean difference, 5 mm). Significant variations among measurements were noted. Some measurements were larger on the lateral cephalogram and some were smaller, but a pattern could be observed: midsagittal measurements were enlarged uniformly, and Co-Gn was changed only slightly; Co-A was always smaller. CONCLUSION: CBCT craniometric measurements are accurate to a subvoxel size and potentially can be used as a quantitative orthodontic diagnostic tool. Two-dimensional cephalometric norms cannot be readily used for three-dimensional measurements because of differences in measurement accuracy between the two exams.