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OBJECTIVE: Development and evaluation of a mobile application for remote monitoring and guidance of pediatric patients diagnosed with cleft lip and/or palate (CL ± P) and their caregivers. DESIGN: This is a pilot cross-sectional, applied, and quantitative study. SETTING: The study was conducted in two tertiary care treatment centers in Brazil. PARTICIPANTS: The participants included 20 caregivers and infants undergoing treatment with nasoalveolar molding (NAM) for CL ± P. INTERVENTIONS: The intervention involved using the TeleCleft mobile application for remote monitoring and guidance of caregivers and infants during NAM treatment. MAIN OUTCOME MEASURE(S): The main outcome measures included usability and satisfaction of users with the TeleCleft application. RESULTS: The results showed high usability and satisfaction ratings among users of the TeleCleft application. Most participants found remote monitoring to be effective and expressed positive opinions about its convenience and usefulness. CONCLUSION: TeleCleft could be a viable tool for remote monitoring and guidance, reducing the need for patients and caregivers to travel to treatment centers, which could potentially alleviate the burden of care faced by families during the journey of CL ± P treatment.

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Introduction: Cleft lip and palate rank third among congenital defects, demanding early intervention for correction. Aim: To describe the results obtained with the use of nasoalveolar molding (NAM) and lip adhesion in patients with complete cleft lip-alveolus-palate, treated in the Maxillofacial Surgery service of the Pediatric Hospital of Matanzas between 2010 and 2020. Methods: An observational, descriptive, prospective research was carried out, in a universe of 16 patients with a diagnosis of complete cleft lip-alveolus-palate, treated in the Maxillofacial Surgery Service of Matanzas pediatric hospital during the period from January 2010 to December 2020, determining reference points to perform linear measurements that represented the study variables, both in patients treated only with nasoalveolar molding and in those in whom the nasoalveolar molding-lip adhesion binomial was used. Results: With the exclusive use of nasoalveolar molding, there was a significant reduction of the palatal cleft in all patients under study, with increase in maxillary and hemi-maxillary transverse dimension, as well as a significant reduction of the alveolar cleft. The total reduction of the alveolar cleft was only achieved by combining lip adhesion with nasoalveolar molding. Conclusion: The nasoalveolar molding-lip adhesion combination constitutes an effective binomial in the treatment of complete cleft lip-alveolus-palate.

Introducción: Las fisuras de labio y paladar ocupan el tercer lugar entre los defectos congénitos, demandando una temprana intervención para su corrección. Objetivo: Describir los resultados del empleo del moldeo nasoalveolar y la adhesión labial en pacientes con fisura labio-alveolo-palatina completa, atendidos en el Servicio de Cirugía Maxilofacial del hospital pediátrico de Matanzas, entre 2010 y 2020. Métodos: Se realizó una investigación observacional, descriptiva, prospectiva, en un universo de 16 pacientes con diagnóstico de fisura labio-alveolo-palatina completa, atendidos en el Servicio de Cirugía Maxilofacial del hospital pediátrico de Matanzas, durante el período comprendido de enero de 2010 a diciembre de 2020, determinándose puntos de referencia para realizar mediciones lineales que representaron las variables de estudio, tanto en pacientes atendidos solo con moldeo nasoalveolar como en los que se empleó el binomio moldeo nasoalveolar-adhesión labial. Resultados: Con el empleo exclusivo del moldeo nasoalveolar, existió una significativa reducción de la hendidura palatina en los pacientes estudiados, con incremento de la dimensión transversal maxilar y hemimaxilar, así como una significativa reducción de la hendidura alveolar. La reducción total de la hendidura alveolar solo se logró al combinar la adhesión labial con el moldeo nasoalveolar. Conclusión: La combinación moldeo nasoalveolar-adhesión labial constituye un binomio efectivo en el tratamiento de la fisura labio-alveolo-palatina completa.

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BACKGROUND: Unilateral cleft lip and / or palate (UCL/P) is one of the most common congenital craniofacial differences. The objective of this study was to describe the maternal perception of breastfeeding in children with unilateral cleft lip and palate and to assess the role of breastfeeding counseling. METHODS: This study was conducted using an interpretive phenomenological approach to explore the experience from the perspectives of mothers breastfeeding her UCL/P child. Twenty-eight mothers of patients with nonsyndromic UCL/P treated with nasoalveolar molding (NAM) therapy between April 2015 and April 2018 were selected during consultations at the Fundación Clínica Noel in Medellín, Colombia. Thematic analysis was conducted for qualitative data. RESULTS: The findings resulted in six main categories: First contact with the CL/P team, access to early diagnosis and timely treatment, perceptions of parents about health personnel on breastfeeding of CL/P patients, perceptions of mothers toward breastfeeding, perception of advantages and disadvantages of the NAM technique regarding breastfeeding and assessment of the CL/P team. The interviewed mothers, both prenatally and postnatally, stated the benefits of initiating the process prenatally. There are still difficulties in reaching a timely diagnosis. Several mothers noted that health professionals and assistants determined the hospitalization, installation of a nasogastric tube or feeding through a baby bottle or syringe, which prevented the first contact between mother and child. Even though the exclusive breastfeeding process is difficult for these mothers, they acknowledge its immense advantages. Interviewed mothers considered using the NAM therapy advantageous as the obturator allowed a better bottle-feeding process. The interdisciplinary team generates satisfaction, motivation, expectations and happiness in the mothers who initiated this therapy with their children. CONCLUSION: The participants related difficulties with exclusive breastfeeding. Mothers acknowledged the clinical results when using the NAM therapy and the support provided by the IBCLC. We encourage health providers in Medellín, Colombia, to seek education to enhance their clinical skills and promote and protect breastfeeding. Also, health professionals in other cities or countries could consider search more breastfeeding education as well.

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As fissuras congênitas de lábio e/ou palato, também conhecidas como fenda labial, fenda labiopalatina e fenda palatina, fazem parte de um conjunto de doenças que afetam a cavidade oral e os lábios. As causas ainda são desconhecidas, mas podem estar relacionadas a fatores genéticos e ambientais. As fendas orofaciais estão dentre as malformações crânio-faciais mais comuns presentes desde o nascimento. O bebê afetado precisará desde o seu nascimento até a sua vida adulta de acompanhamento e tratamento com equipes multidisciplinares, e dentre eles o tratamento ortodôntico é fundamental. O modelador nasoalveolar (NAM) consiste em uma placa intraoral onde o intuito é de diminuir a gravidade da deformidade da fenda original, no pré-cirúrgico e permitir que o cirurgião obtenha um melhor reparo do alvéolo, lábio e nariz nos pacientes que possuem a fissura. Sendo assim, o objetivo do seguinte trabalho é de avaliar o resultado do uso do NAM e da queiloplastia na obtenção da simetria facial e da maxila em bebês fissurados tratados na Faculdade de Odontologia da Universidade Federal de Minas Gerais, por meio de análise de imagens fotográficas realizadas durante os atendimentos clínicos num período de pré-cirúrgico, cirúrgico e pós-cirúrgico, além de modelos digitais moldados antes do tratamento e pós o uso do NAM.

Congenital cleft lip and/or palate, also known as cleft lip, cleft lip and palate, and cleft palate, are part of a set of diseases that affect the oral cavity and lips. The causes are still unknown, but they may be related to genetic and environmental factors. Orofacial clefts are among the most common craniofacial malformations present from birth. The affected baby will need, from birth to adulthood, follow-up and treatment with multidisciplinary teams, and among them, orthodontic treatment is essential. The Nasoalveolar Modeler (NAM) consists of an intraoral plate whose purpose is to reduce the severity of the deformity of the original cleft, in the pre-surgical period and allow the surgeon to obtain a better repair of the alveolus, lip and nose in patients with cleft. Therefore, the objective of the following work is to evaluate the result of using NAM and cheiloplasty in obtaining facial and maxillary symmetry in cleft babies treated at the Faculty of Dentistry, Federal University of Minas Gerais, through photographic image analysis performed during clinical care in a pre-surgical, surgical and post- surgical period, in addition to molded digital models before treatment and after the use of NAM.

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Resumen Introducción: El labio y paladar hendido son malformaciones craneofaciales que se presentan en 1:1000 nacidos vivos en Colombia. Realizar un moldeado nasoalveolar previo a la cirugía favorece el reposicionamiento de los cartílagos nasales deformados y de los procesos alveolares. Objetivo: Dar a conocer a los profesionales la importancia de realizar moldeado nasoalveolar en un paciente con labio y paladar hendido antes de la intervención quirúrgica. Materiales y métodos: En la clínica odontológica de la Universidad del Sinú de Montería (Córdoba, Colombia), se atendió una paciente de 17 días de nacida que presentaba labio y paladar hendido completo unilateral izquierdo severo. Luego de diligenciar la historia clínica odontológica, se realizó placa de órtesis, que se cambió cada 15 días y se hizo el retoque del "tutor" cada 8 días. Resultados: La placa de órtesis permitió un moldeado naso alveolar, con el progreso en la alimentación y mejoras en el contorneado de los tejidos nasales, que mejoró la preparación para la operación de la hendidura a los 8 meses de edad. Conclusiones: La importancia del moldeado nasoalveolar en casos como el presentado, es propiciar mejores condiciones físicas, favoreciendo la ingesta de alimentos y beneficiando la apariencia física.

Abstract Introduction: Cleft lip and palate is a craniofacial birth defect that accounts for 1:1000 live birhts in Colombia. Performing nasoalveolar molding before surgery facilitates the reshaping of deformed nasal cartilage and alveolar processes. Objective: To make professionals aware of the importance of performing nasoalveolar molding in a patient with cleft lip and palate before surgical intervention. Materials and methods: A 17-day-old infant with a full left unilateral cleft lip and palate was treated at the dental clinic of the University of Sinú, Montería (Córdoba, Colombia). Once the dental clinical history was recorded, an orthosis plate was made. The plate was changed every 15 days and the molding appliance was repositioned every 8 days. Results: The orthosis plate promoted nasoalveolar molding, which facilitated feeding and improved the shape of nasal tissues. Consequently, this early intervention improved the preparation for the surgery of the cleft when the child reached 8 months of age. Conclusions: Nasoalveolar molding in patients with full cleft lip and palate is important to promote better physical conditions, which favor food intake and benefit their physical appearance.

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Abstract The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient's lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

Resumo Os objetivos da ortopedia pré-cirúrgica são permitir a correção cirúrgica com mínima tensão dos tecidos envolvidos e menor restrição ao crescimento craniofacial. O objetivo deste estudo foi avaliar os benefícios do modelo nasoalveolar (NAM) como terapia pré-operatória em um paciente com fissura labiopalatina bilateral seguida de labioplastia e palatoplastia. Um paciente de 15 dias de idade foi submetido a tratamento ortopédico com NAM. Após o tratamento pré-operatório, observou-se retração da pré-maxila com redução da fissura. Devido aos efeitos bem-sucedidos do tratamento com NAM, o paciente realizou a cirurgia em um único tempo cirúrgico para correção dos lábios. Seis meses após verificou-se a continuidade da redução da fissura devido à pressão labial. Após dozes meses, o paciente foi submetido à palatoplastia. Ambas as cirurgias contribuíram para o fechamento remanescente da fissura, que foram reduzidas pela metade em comparação com o final do tratamento pré-operatório. O uso do NAM como tratamento pré-operatório proporcionou a aproximação dos segmentos alveolares, centralização da pré-maxila, diminuição da fissura palatina, resultando em melhora acentuada do arco, resultando em procedimentos cirúrgicos mais eficazes. Além disso, permitiu o reparo primário do lábio do paciente com fissura bilateral assimétrica em apenas uma cirurgia; em conseqüência, reduzindo a morbidade do tratamento e diminuição dos custos do tratamento.

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Objetivo: relatar um caso clínico com abordagem ortopédica pré-cirúrgica em paciente portador de fissura pré-forame incisivo unilateral esquerda realizada a partir do modelador nasoalveolar (NAM) construído por meio de engenharia reversa (ER). Metodologia: Paciente do sexo masculino, 1 mês de idade, portador de fissura pré- forame unilateral esquerda completa, foi submetido ao tratamento pré-cirúrgico com NAM-ER. Inicialmente foi realizada a moldagem do arco superior, seguida do escaneamento do molde e, a partir deste, criado um modelo digital para realizar o planejamento virtual do caso. Após a aprovação do planejamento foram impressos os modelos que serviram de base para a confecção das placas alveolares. As placas alveolares foram trocadas semanalmente e utilizadas associadas à um componente nasal (elevador nasal) e às fitas adesivas labiais. Para avaliação do sucesso do uso do NAM-ER foram realizadas medidas da largura da fissura (F-F'), da largura da região intercaninos (C-C') e da largura da região intermolares (M-M'), no tempo inicial (T0), pré-cirúrgico (T1) e pós-cirúrgico (T2). Resultados: A medida F-F' sofreu uma diminuição total (T0-T2) de 3,18mm, sendo que 1,09mm ocorreu no intervalo de tempo de T0-T1 e 2,09mm de T1-T2. As distâncias C-C' e M-M' apresentaram um aumento dos seus comprimentos em todos os tempos medidos. C-C' apresentou um aumento de 3,48mm total (T0-T2), sendo que 2,41mm no intervado entre T0-T1 e 1,07mm no intervalo de T1-T2. Já M-M' teve um aumento total(T0-T2) de 4,56mm, sendo 4,38mm no intervalo de T0-T1e 0,18mm no intervalo de T1-T2. Conclusão: O NAM construído a partir da engenharia reversa utilizado juntamente com o elevador nasal e as fitas adesivas no lábio mostrou-se efetivo na modelagem nasoalveolar, evidenciando uma diminuição na largura da fissura com melhor conformação dos segmentos alveolares. Com a ER foi possível diminuir a quantidade de consultas e diminuir o tempo clínico de cada atendimento.

Objective: to report a clinical case of pre-surgical orthopedic treatment in a patient with pre-foramen unilateral cleft palate performed from the nasal-alveolar molding (NAM) constructed through reverse engineering (RE).Method: a 1-month-old male patient with complete unilateral cleft lip and palate on the left side was submitted to preoperative NAM-RE treatment. Initially the upper arch molding was carried out, followed by the scanning of the mold and, from this, a digital model was created to carry out the virtual planning of the case. After approval of the planning, the models that served as the basis for the preparation of the alveolar plates were printed. The alveolar plates were changed weekly and used associated with a nasal component and lip adhesive. In order to evaluate the success of NAM-RE, measurements of the width of the gap (F-F '), the width of the intercanine region (C-C') and the width of the intermolar region (M- M) in the initial moment (T0), pre-surgical (T1) and postoperative (T2).Results: the F- F 'measure had a total decrease (T0-T2) of 3.18 mm, with 1.09 mm occurring in the time interval of T0-T1 and 2.09 mm in T1-T2. The distances C-C' and M-M' showed an increase in their lengths at all times measured. C-C' showed a total increase of 3.48mm (T0-T2), with 2.41mm in the interval between T0-T1 and 1.07mm in the T1-T2 interval. The distance M-M' had a total increase (T0-T2) of 4.56mm, being 4.38mm in the interval of T0-T1e and 0.18mm in the interval of T1-T2.Conclusion: the NAM constructed from reverse engineering proved to be effective in nasoalveolar modeling, evidencing a decrease in the width of the fissure with better conformation of the alveolar segments. With ER, it was possible to reduce the number of visits and decrease the clinical time of each care.

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As fissuras orofaciais representam a segunda maior causa de anomalias congênitas em nascidos vivos. O tratamento dos pacientes com essas fissuras costuma ser de difícil manejo, sobretudo, quando as lesões são amplas e associadas à extensa deformidade nasolabial. O objetivo da presente revisão de literatura foi avaliar o efeito da moldagem nasoalveolar na assimetria nasal e na largura da fissura alveolar em bebês portadores de fissuras labiopalatinas. Uma pesquisa bibliográfica de cinco bancos de dados eletrônicos obteve 444 artigos sobre moldagem nasoalveolar, dos quais 16 foram ensaios clínicos que incluíam os seguintes critérios: participantes - lactentes portadores de fissura labiopalatina, intervenção - NAM, comparação - outro tratamento ou nenhum tratamento, e desfecho - resultado na assimetria nasal e na largura da fissura alveolar. Dos dezesseis estudos incluídos nesta revisão, onze apresentaram diferença estatisticamente significante em algum desfecho avaliado (simetria nasal ou largura da fissura alveolar). Com isso pode-se concluir que existe um papel significativo da moldagem nasoalveolar pré-cirúrgica no tratamento da fissura labiopalatina.(AU)

Orofacial clefts are the second leading cause of birth defects in live births. Treatment of patients with these clefts often unwieldy, especially when the lesions are large and associated with extensive nasolabial deformity. The aim of the present review was to evaluate the effect of Nasoalveolar Molding on nasal assymmetry and on the width of the alveolar cleft in infants. A literature search of five eletronic databases retrieved 444 articles regarding nasoalveolar molding, 16 of which were clinical trials that includes the following criteria: participants - cleft lip and palate infants, intervention - NAM, comparison - other treatment or no treatment, and outcome - effect on nasal assymmetry and on the width of the alveolar cleft. Of the sixteen studies included in this review, eleven showed a statistically significant difference in any measured outcome (nasal symmetry or width of the alveolar cleft), it can be concluded that there is a significant part of presurgical nasoalveolar molding in the treatment of cleft lip and palate.(AU)

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O tratamento das fissuras lábio-palatinas evoluiu muito nas últimas décadas. O tratamento atual da deformidade inclui técnicas ortopédicas de modelagem nasoalveolar como a Modelagem Nasoalveolar Passiva (MNA), que tem por objetivo a redução da largura da fissura alveolar e do palato, bem como da modelagem da região nasal afetada, logo após o nascimento. A MNA é iniciada na primeira semana de vida e se continua durante os primeiros meses, até a data do fechamento cirúrgico do lábio. O presente artigo relata o caso de um recém-nascido com diagnóstico ultrassonográfico de fissura lábio-alveolar. O diagnóstico precoce possibilitou o encaminhamento para o especialista, de tal forma que o tratamento foi iniciado logo após o nascimento. Ao final da MNA, a operação de correção da fissura nasoalveolar determinou o fechamento completo do defeito, e o aspecto da região tratada se assemelhava ao do lado não afetado.

The care of lip and palate clefts has progressed a lot in the last decades. Current treatment of the deformity includes orthopedic techniques of nasoalveolar molding such as the passive Nasoalveolar Molding (NAM), which is intended to reduce the width of the alveolar and palate cleft, as well as reshaping the affected nasal area, soon after birth. NAM is indicated to be performed in the first week of life and be continued over the next months, up to the eventual surgical closure of the lip. The present paper reports the case of a newborn with an ultrasonographic diagnosis of cleft alveolus and lip. Early diagnosis made it possible to promptly refer the patient to a specialist, so that treatment began soon after birth. At the end of NAM, the procedure to correct the nasoalveolar cleft determined the complete closure of the defect, and the aspect of the treated area can be appreciated.

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