الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cleft lip and palate is considered one of the most congenital anomalies worldwide. Regarding the severity, complete bilateral cleft lip and palate (CBCLP) infants are considered the most challenging cases to be treated. For optimum esthetical and functional outcomes, the management of those infants should be done by a team of different specialists through a multidisciplinary way of treatment.
This study was conducted on 15 selected infants with bilateral complete cleft lip and palate of less than one month old. Impressions were made using poly-vinyl-siloxane impression material to obtain master casts. The casts were scanned, a proposal to the future position of the premaxilla was suggested, and the angle of the deviation of the premaxilla was measured.
To retract the premaxilla, a two-piece modified acrylic active appliance was used for each infant. Two extraoral side tension arms were used as a primary mean of retention and head caps were added as an assistive retention aid. After the cleft gap had reached the pre-proposed position, the appliance was converted to a feeding plate to start presurgical dynamic nasal remolding (PDNR). Dynamic nasal bump (DNB) was added to the labial flange of the feeding plate.
After complete nasal molding, primary surgical lip repair was performed using a straight-line closure technique. Following 10 days of the surgery (after suture removal) static impression was made to the nose of the infant. Custom- made acrylic nasal retainer was constructed for each infant to preserve the final shape of the nasal tissues, prevent scar tissue contraction following the surgery, and to continue- to some extent- columella lengthening.
The premaxilla assessment was done using 3D laser scanning and microscopic evaluation to measure the changes in the position of the premaxilla at three different time intervals. Nasal anthropometric analysis was done using digital photographs.
Regarding the maxilla, the results showed that there was a statistically significant retraction of the premaxilla with a preferable cleft gap distance. For nasal anthropometric analysis, it was found that presurgical dynamic nasal remodeling increases the columella length and provide better nasal tip height. The nasal retainers also were found to correct the remaining nasal disfigurement and preserve the final esthetics of the nasal tissues.