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Normative Palatal Measurements in Infants: Implications for Nasoalveolar Molding in Cleft Lip and Palate Patients
Katherine A Gossett1, Serena N Kassam2, Tyler M Rist3
1Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston Salem, NC.
Insights
Nasoalveolar molding (NAM) in infants with cleft lip ± palate (CL/P) can be guided by defined palate dimensions. Predictable palate growth occurs between 30-44 weeks, with canine and molar widths being key indicators.
Area of Science:
- Craniofacial development
- Pediatric orthopedics
- Medical imaging
Background:
- Infants with cleft lip ± palate (CL/P) often receive nasoalveolar molding (NAM) pre-surgically.
- NAM aims to align arches and facilitate tension-free surgical closure.
- Established endpoints for arch dimensions in NAM are currently lacking.
Purpose of the Study:
- To define the typical size and shape of infant palates.
- Utilized magnetic resonance imaging (MRI) to identify key anatomical landmarks.
- Focused on infants without CL/P for baseline data.
Main Methods:
- Reviewed MRI scans of 92 infants (<3 months old) without cleft palate.
- Measured 13 distinct palatal dimensions, including distances and angles.
- Key landmarks: incisive foramen (IF), incisors (IN), middle of canines (MOC), and first molars (FM).
Main Results:
- Palatal growth was observed between 30 and 44 weeks gestation.
- Slowest growth noted between IF and IN (0.06 cm); greatest growth between FM widths (0.7 cm).
- Width measurements between MOC (J) and FM (K) showed the strongest positive correlation with age (0.55 and 0.61).
Conclusions:
- Infant palate exhibits predictable growth patterns from 30 to 44 weeks.
- Canine and first molar widths are the most reliable predictors of palate dimensions.
- These findings can inform pre-surgical orthopedic treatment for infants with CL/P.
Background:
Children with cleft lip ± palate (CL/P) may undergo nasoalveolar molding (NAM) before surgery to achieve arch alignment and tension-free closure, yet the endpoint of arch dimensions has not been defined.
Objective:
To characterize the size and shape of infant palates using anatomic landmarks on magnetic resonance imaging in infants without CL/P.
Methods:
Magnetic resonance imaging of infants without cleft palate younger than 3 months were reviewed and 13 measurements were taken to define palatal shape: distance between incisive foramen (IF) and incisors (IN), IF and middle of canines (MOC), between MOCs, between first molars (FM), 2 depth and 4 angle measurements.
Results:
Ninety-two infants between 30 and 44 weeks old were included. Pre-maxillary growth from 30 to 44 weeks demonstrated the slowest growth (0.06 cm) from IF to between IN (B) and the greatest growth (0.7 cm) between the width of FM (K). The measurements between MOC (J) and between FMs (K) had the highest positive correlation to age at 0.55 and 0.61, respectively.
Conclusion:
There was predictable growth of the palate noted between 30 and 44 weeks, with the most predictive measurements represented by the width of the canines and first molar locations along the alveolus. These values can help guide pre-surgical orthopedics in infants with CL/P.
