일측성 구순열 교정시 술자가 제작한 술전 비치조 교정기의 효과에 대한 연구

Abstract

The author treated unilateral cleft lip and palate using presurgical nasal and alveolar molding(NAM) device which was introduced in 1993 by Grayson. In our cases(n=17), the author made the device by himself and performed presurgical nasoalveolar molding for the unilateral cleft lip and palate patients. Presurgical NAM device was applied in the second week following birth, and nasal stent for nasal cartilage molding was applied during nasoalveolar molding process around 6weeks after birth. Presurgical NAM was continued until repositioning of the nasal cartilages and alveolar processes(interalveolar gap<2mm), and lengthning of the deficient columella(mean vertical height of columella at postop 3months, 12months and 24months: preop. 1.5mm -> postop 3months 4.5mm->postop. 12months 3.5mm->postop. 24months ->3.2mm). The primary lip-nose repair and gingivoperiosteoplasty were performed within 6months of following birth(mean age : 17weeks). Even though not evaluating the longterm follow-up study in our cases, This technique permits a one-stage repair of the lip, nose and alveolus where previously a three-stage repair was necessary: primary lip repair, secondary rhinoplasty and alveolar repair with bone graft. In conclusion, followings are advantages of this techniques. 1) It could be lengthened defected columella without additional surgical procedure. 2) It could be avoided a complication as like meganostril and delaying of operation time. 3) Primary gingivoperiosteoplasty was able after result of interalveolar narrowing less than 2mm by using of Surgeon-Made Nasoalveolar Molding Device. 4) It could be performed lip repair easily. 5) The Surgeon-Made Device could be helpful for milk feeding in cases of complete cleft palate. 6) It could be doing easier of secondary surgery. 7) It could be reducing parents psychologic burdens. 8) It could be getting of improved Doctor to Parents relationship.