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- DOI doi: 10.18231/j.jco.9933.1463658578
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CrossMark
- Citation
Feeding effectiveness of nasoalveolar molding appliances made with polymethyl methacrylate vs. polyamide in newborns with unilateral cleft lip and palate: A randomized controlled trial
- Author Details:
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Sangeetha Morekonda Gnaneswar *
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Nirmala Anandan
Background: Infants with cleft lip and palate face feeding challenges due to anatomical disruptions, leading to complications like nasal regurgitation, choking, and poor nutrition. Nasoalveolar molding (NAM) appliances, traditionally made from polymethyl methacrylate (PMMA), reduce the severity of cleft before surgery, help seal the oronasal opening and improve feeding. PMMA’s rigidity limits adaptability, potentially reducing feeding efficiency. Polyamide, a crystalline polymer with higher flexibility and reduced thickness may provide a better anatomical adaptation, enhancing feeding performance.
Aim: To evaluate the feeding effectiveness of NAM appliances made from PMMA versus polyamide in newborns with unilateral cleft lip and palate.
Materials and Methods: A clinical trial (2020–2024) at two Indian hospitals enrolled 76 infants, randomized into Group A (PMMA) and Group B (polyamide). After attrition, 58 infants remained. NAM appliances were activated biweekly. Bottle-feeding volumes were measured three days before and after NAM placement and at weeks 4 and 8. Weight was recorded at baseline (T0), Day 3 (T1), Weeks 4 (T2), 8 (T3), and 12 (T4) respectively. Results: Group B had significantly higher feeding volumes on Day 3 (662 ml and 627.87 ml, p = 0.001) and over the three-day average (627.12 ml and 608.5 ml, p = 0.040). No significant difference was noted at Week 4 (p = 0.103), but Week 8 showed improvement in Group B (1141.25 ml and 1110 ml, p = 0.045). Weight gain was significantly higher in Group B at T1 (0.16 kg, p = 0.047), T3 (0.32 kg, p = 0.0003), and T4 (0.35 kg, p = 0.0482). Conclusion: Polyamide NAM appliances demonstrated superior feeding effectiveness and weight gain, supporting their use when feasible.
References
- Young JL, O'Riordan M, Goldstein JA, Robin NH. What information do parents of newborns with cleft lip, palate or both want to know? Cleft Palate Craniofac J. 2001;38(1):55–8. DOI:
- 1597/1545-1569_2001_038_0055_widpon_2.0.co_2.
- Avedian L, Ruberg R. Impaired weight gain in cleft palate infants. Cleft Palate J. 1980;17(1):24–6.
- Becker M, Svensson H, Källén B. Birth weight, body length, and cranial circumference in newborns with cleft lip and palate. Cleft Palate Craniofac J. 1998;35(3):255–61. DOI: 10.1597/1545-
[Google Scholar] 1569_1998_035_0255_bwblac_2.3.co_2. - Jones WB. Weight gain and feeding in the neonate with cleft: a three-center study. Cleft Palate J. 1988;25(4):379–84.
- Choi BH, Kleinheinz J, Joos U, Komposch G. Sucking efficacy of early orthopaedic plate and teats in infants with cleft lip and palate. Int J Oral Maxillofac Surg. 1991;20(3):167–9. DOI: 10.1016/s0901-5027(05)80009-8
[Google Scholar] - Gopinath VK, Muda WA. Assessment of growth and feeding in children with cleft lip and palate. Southeast Asian J Trop Med Public Health. 2005;36(1):254–8.
- Masarei AG, Sell D, Habel A, Mars M, Sommerland BC, Wade A. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate Craniofac J. 2007;44(3):321–8. DOI: 10.1597/05-185
[Google Scholar] - Madhoun LL, Crerand CE, O'Brien M, Baylis AL. Feeding and growth in infants with cleft lip and/or palate: relationships with maternal distress. Cleft Palate Craniofac J. 2021;58(4):470–8. DOI: 10.1177/1055665620956873
[Google Scholar] - Goldberg WB, Ferguson FS, Miles RJ. Successful use of a feeding obturator for an infant with a cleft palate. Spec Care Dent. 1988;8(2):86–9. DOI: 10.1111/j.1754-4505.1988.tb00699.x
[Google Scholar] - McNeil C. Congenital cleft palate; a case of congenital cleft palate which required the fitting of a special appliance. Br Dent J. 1948;84(7):137–41.
- Oliver HT. Construction of orthodontic appliances for the treatment of newborn infants with clefts of the lip and palate. Am J Orthod. 1969;56(5):468–73. DOI: 10.1016/0002-9416(69)90208-5
[Google Scholar] - Kogo M, Okada G, Ishii S, et al. Breastfeeding for cleft lip and palate patients using the Hotz-type plate. Cleft Palate Craniofac J. 1997;34(4):351–3. DOI: 10.1597/1545-
[Google Scholar] 1569_1997_034_0350_bffcla_2.3.co_2 - Turner L, Jacobsen C, Humenczuk M. The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate. Cleft Palate Craniofac J. 2001;38:519–24. DOI: 10.1597/15451569_2001_038_0519_
[Google Scholar] teolea_2.0.co_2. - Hansen PA, Cook NB, Ahmad O. Fabrication of a feeding obturator for infants. Cleft Palate Craniofac J. 2016;53(2):240–4. DOI: 10.1597/14-029
[Google Scholar] - Prahl C, Kuijpers-Jagtman AM, Van ‘t Hof MA, Prahl-Andersen B. Infant orthopedics in UCLP: effect on feeding, weight, and length: a randomized clinical trial (Dutchcleft). Cleft Palate Craniofac J. 2005;42(2):171–7. DOI: 10.1597/03-111.1
[Google Scholar] - Matsuo K, Hirose T. Preoperative non-surgical overcorrection of cleft lip nasal deformity. Br J Plast Surg. 1991;44(1):5–1. DOI: 10.1016/0007-1226(91)90168-j
[Google Scholar] 514 Gnaneswar and Anandan/ Journal of Contemporary Orthodontics 2025;9(4):506–514 - Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36(6):486–98. DOI: 10.1597/1545-
[Google Scholar] 1569_1999_036_0486_pnmiiw_2.3.co_2. - Gomez DF, Donohue ST, Figueroa AA, Polley JW. Nasal changes after presurgical nasoalveolar molding (PNAM) in the unilateral cleft lip nose. Cleft Palate Craniofac J. 2012;49(6):689–700. DOI: 10.1597/11-007
[Google Scholar] - Yunus N, Rashid AA, Azmi LL, Abu Hassan MI. Some flexural properties of a nylon denture base polymer. J Oral Rehabil. 2005;32(1):65–71. DOI: 10.1111/j.1365-2842.2004.01370.x
[Google Scholar] - Takabayashi Y. Characteristics of denture thermoplastic resins for non-metal clasp dentures. Dent Mater J. 2010;29(4):353–61. DOI: 10.4012/dmj.2009-114
[Google Scholar] - Hamanaka I, Takahashi Y, Shimizu H. Mechanical properties of injection-molded thermoplastic denture base resins. Acta Odontol Scand. 2011;69(2):75–9. DOI: 10.3109/00016357.2010.517557
[Google Scholar] - Rau A, Ritschl LM, Mücke T, Wolff KD, Loeffelbein DJ (2015) Nasoalveolar Molding in Cleft Care—Experience in 40 Patients from a Single Centre in Germany. PLOS ONE 10(3): e0118103. https://doi.org/10.1371/journal.pone.0118103
[Google Scholar] - Kümbüloğlu Ö, Yildirim B, Al-Haj Husain N, Özcan M. Adhesion potential of relining materials to polyamide and PMMA-based denture base materials: effect of surface conditioning methods. J Adhes Sci Technol. 2019;33(17):1939–47. DOI:10.1080/01694243.2019.1617935
[Google Scholar] - Shimpo H, Ohkubo C. Bonding of auto-polymerized poly(methyl methacrylate) resin to polyamide thermoplastic resin. Asian Pac J Dent. 2019;19(2):65–9. DOI:10.47416/apjod.19-0266
[Google Scholar] - Danner SC. Breastfeeding the infant with a cleft defect. NAACOGS Clin Issues Perinat Womens Health Nurs. 1992;3(4):634–9.
- Pathumwiwatana P, Tongsukho S, Naratippakorn T, Pradubwong S, Chusilp K. The first 6 months after childbirth at Srinagarind Hospital, Khon Kaen Province, Thailand. J Med Assoc Thai. 2010;93(4):S71–7.
- Britton KFM, McDonald SH, Welbury RR. An investigation into infant feeding in children born with a cleft lip and/or palate in the West of Scotland. Eur Arch Paediatr Dent. 2011;12(5):250–5. DOI: 10.1007/BF03262817
[Google Scholar] - Al Khateeb KA, Fotouh MA, Abdelsayed F, Fahim F. Short-term efficacy of presurgical vacuum-formed nasoalveolar molding aligners in infants with unilateral cleft lip and palate: A prospective clinical trial. Cleft Palate Craniofac J. 2021;58(7):815–23. DOI: 10.1177/1055665620966189
[Google Scholar] - Oday R, Abid M, Dziedzic A. The accuracy and retention of presurgical infant orthopaedics constructed from different polymer materials: A comparative study. J Taibah Univ Med Sci. 2024;19(2):379–89. DOI: 10.1016/j.jtumed.2024.01.005
[Google Scholar] - Alansari N, Abid M, Dziedzic A. Enhanced antimicrobial efficacy of chlorhexidine-encapsulated halloysite nanotubes incorporated in presurgical orthopedic appliances: an in vitro, controlled study. Clin Oral Investig. 2024;28(1):68. DOI: 10.1007/s00784-023-05464-7
[Google Scholar] - Martin V, Greatrex-White S. An evaluation of factors influencing feeding in babies with a cleft palate. J Child Health Care. 2014;18(1):72–83. DOI: 10.1177/1367493512473853
[Google Scholar] - Woods SM, Garfinkle JS, Covell DA J, Wang M, Busch LS, Doyle LM. Early Weight Gain in Infants With Cleft Lip and Palate Treated With and Without Nasoalveolar Molding: A Retrospective Study. Cleft Palate Craniofac J. 2019;56(7):902–7. DOI: 10.1177/1055665618815396
[Google Scholar] - Shaw WC, Bannister RP, Roberts CT. Assisted feeding is more reliable for infants with clefts--a randomized trial. Cleft Palate Craniofac J. 1999;36(3):262–8. DOI: 10.1597/1545-
[Google Scholar] 1569_1999_036_0262_afimrf_2.3.co_2.
How to Cite This Article
Vancouver
Gnaneswar SM, Anandan N. Feeding effectiveness of nasoalveolar molding appliances made with polymethyl methacrylate vs. polyamide in newborns with unilateral cleft lip and palate: A randomized controlled trial [Internet]. J Contemp Orthod. 2025 [cited 2025 Oct 28];9(4):506-514. Available from: https://doi.org/doi: 10.18231/j.jco.9933.1463658578
APA
Gnaneswar, S. M., Anandan, N. (2025). Feeding effectiveness of nasoalveolar molding appliances made with polymethyl methacrylate vs. polyamide in newborns with unilateral cleft lip and palate: A randomized controlled trial. J Contemp Orthod, 9(4), 506-514. https://doi.org/doi: 10.18231/j.jco.9933.1463658578
MLA
Gnaneswar, Sangeetha Morekonda, Anandan, Nirmala. "Feeding effectiveness of nasoalveolar molding appliances made with polymethyl methacrylate vs. polyamide in newborns with unilateral cleft lip and palate: A randomized controlled trial." J Contemp Orthod, vol. 9, no. 4, 2025, pp. 506-514. https://doi.org/doi: 10.18231/j.jco.9933.1463658578
Chicago
Gnaneswar, S. M., Anandan, N.. "Feeding effectiveness of nasoalveolar molding appliances made with polymethyl methacrylate vs. polyamide in newborns with unilateral cleft lip and palate: A randomized controlled trial." J Contemp Orthod 9, no. 4 (2025): 506-514. https://doi.org/doi: 10.18231/j.jco.9933.1463658578