Presurgical infant orthopedics has been used for centuries in the treatment of cleft lip and palate. However, traditional techniques often fail to address the nasal cartilage deformity in both unilateral and bilateral cleft lip and palate, as well as the columella tissue deficiency in bilateral cases. Naso-alveolar moulding (NAM) is a presurgical technique designed to reshape the alveolus, lip, and nose in infants born with cleft lip and palate. This approach reduces the severity of the cleft-related deformities, leading to improved surgical outcomes. The NAM appliance consists of an intraoral moulding plate with nasal stents, which work simultaneously to reshape the alveolar ridge and nasal cartilage. The primary objective of presurgical NAM is to minimize the initial cleft severity, eliminate the need for surgical columella reconstruction, and reduce scar tissue formation in bilateral cleft lip and palate cases. Cleft lip and palate treatment has been available in Jordan’s Royal Medical Services (RMS) since the late 1980s, with various presurgical orthopaedic techniques being implemented over the years. Over the past eight years, NAM treatment—seven years at the Royal Rehabilitation Center-RMS and one year at Al-Bashir Hospital (MOH)—has demonstrated significant improvements in primary surgical repair outcomes when compared to other presurgical orthopedic methods. This abstract provides an overview of the NAM technique, highlight the benefits observed over eight years of clinical experience, and showcase selected case studies.

Cleft lip palate is a common congenital anomaly in our population. It imposes serious psychological and social disturbances in both children and their families, Long complex treatment plans, and procedures Centralization of cleft care led to the great evolution of pre surgical orthodontist management and the continuous rejuvenation in surgical techniques. In this presentation we explore our experience and current practice at the Royal Jordanian Rehabilitation center cleft unit, which were based on successful centralization of cleft lip care with strict commitment to rules of modern cleft multidisciplinary care.

The primary purposes of NAM are a reduction of the severity of cleft area, approximation of lip segments, up-righting of the columella and molding of the ala of the nose at cleft side. Achieving these results make the surgery tension free, very fine scar area, reduce the need for bone graft in the future and symmetrical nostrils. Treatment of cleft lip and palate patient need a multidisciplinary team to deliver comprehensive care. The best time to start treatment is as early as possible after the diagnosis of the case, and this is stage one of treatment which is considered a pre-surgical phase. In this stage, we use special appliances to mold the nose and the alveolus and to approximate the lip segment together to ensure the best aesthetic appearance, less scar formation, tension-free surgery, and reduce the size of the cleft area. These appliances are called NAM (Naso-Alveolar Molding Appliances), to construct the NAM appliance we have to take an impression of the upper arch of the newborn baby and send it to the lab, and deliver the appliance on the same day. Then the patient needs to be seen every 7-10 days to activate the appliance and to make sure the good compliance by the parent. In most cases when the size of the cleft area is reduced to 5 mm or less, we add the nasal piece which helps to elevate the ala of the nose in the cleft area and aid in the creation and correction of the deviated columella of the nose. Clear protocol of treatment stages is needed as the timing of all the treatment stages is very important to make sure to deliver professional care and ensure the best result and improvement. Using NAM appliance could cause complications but not severe. The most common issue is irritation and sometimes ulceration of the delicate oral tissues.

In our study we will demonstrate the outcome of using long term ventilation tubes (T-tubes) in cleft palate patients regarding hearing and clinical examination of the ear according to our experience in Queen Rania hospital.

Non-syndromic cleft lip and/or palate (NSCL/P) is among the most common congenital craniofacial anomalies, traditionally studied for its structural and functional impacts on the orofacial region. However, emerging neuroimaging evidence suggests that NSCL/P may also be associated with subtle but consistent alterations in brain development. This review and meta- analysis aims to synthesize the current literature on brain structural differences in individuals with NSCL/P compared to unaffected controls. Following a systematic search of relevant databases, studies utilizing MRI to assess brain morphology in NSCL/P populations were identified and quantitatively analyzed. The meta- analysis revealed a significant reduction in both overall intracranial volume and total cerebellar volume among individuals with NSCL/P. These findings suggest that the condition may involve neurodevelopmental differences extending beyond the cleft region, potentially contributing to the cognitive and behavioral outcomes observed in some affected individuals. The results underscore the importance of a multidisciplinary approach to the care of patients with NSCL/P, integrating insights from craniofacial, orthodontic, and neurodevelopmental perspectives. Further research is warranted to explore the clinical implications of these structural brain differences and their potential influence on treatment planning and long-term outcomes.