A Low-Cost Independent Forehead-Anchored Nasal Molding System Combined with Early Vomer Flap Closure in the Management of Complete Unilateral Cleft Lip and Palate: A Technical Note and Case Report

Abstract

Presurgical nasoalveolar molding (PNAM) remains a valuable adjunct in the management of infants with cleft lip and palate. Traditional Grayson PNAM systems employ a nasal stent attached directly to an intraoral molding plate. Recent developments have proposed split-type PNAM systems utilizing digital workflows and three-dimensional printing technologies. However, access to such technologies remains limited in many regions of the world and to specific high-income patient category. A neonate, 3 days old, presenting with non syndromic isolated complete unilateral cleft lip, alveolus, and palate underwent treatment using a conventional acrylic molding plate and an independent extraoral nasal stent. Following presurgical orthopedic correction, primary cheiloplasty and simultaneous vomer flap closure were performed. Significant improvement in nasal morphology and alveolar approximation was achieved. Following surgical intervention, nasal regurgitation during feeding was eliminated, the feeding plate was discontinued, and conventional bottle feeding became possible. This report introduces a practical modification that separates nasal and alveolar biomechanics while emphasizing functional rehabilitation.