Picture of Nasolabial Cyst (Nasoalveolar Cyst, Klestadt Cyst)

These developmental cysts are rare lesions of the nasal alar region. They grow submucosally in the anterior nasal floor, often elevating and medially displacing the inferior turbinate. They expand downward into the gingivolabial sulcus, and laterally into the soft tissue of the face.

Nasolabial cysts are usually unilateral, more common in women, usually present during the fourth and fifth decades of life, and have a predilection for the black population. They are usually painless and asymptomatic, and they are recognized only when they are acutely inflamed or large enough to cause nasal obstruction. Sometimes their size will cause flattening of the nasolabial fold. They are generally thought to be of embryonic origin, arising where nasal epithelium became trapped in the cleft formed by the fusion of the maxillary, lateral, and medial nasal processes.

What type of NAM is done at Children's?

We use the negative sculpturing passive molding technique described by Drs. Grayson and Cutting. Our surgical technique takes advantage of nasoalveolar molding by decreasing the size of the incisions and scars and the amount of surgery.

In select cases, a gingivoperiosteoplasty can be performed to completely close the cleft in the gum at the time of the surgery.

Doing a GPP at the time of the lip surgery can prevent the need for a future alveolar bone graft (gum surgery) in approximately half of the children. Not all children undergoing NAM are good candidates for a GPP.

We will provide more information on NAM and discuss if it is appropriate for your child.

An orthodontist, a plastic surgeon and a nurse practitioner specially trained in NAM are available for questions between visits.

Although your child will come to the orthodontist for adjustments to the molding plate about once a week, they will still be followed as closely as necessary by the rest of the multidisciplinary team at the Craniofacial Center during regular clinic visits.

What is your experience with nasoalveolar molding?

Dr. Barry Grayson and Dr. Court Cutting at New York University Medical Center developed nasoalveolar molding and have established it as a safe and effective technique.

Although NAM is a more recent advance in cleft care, it is an improvement of techniques that have been used in the U.S. and in Europe for decades. It is therefore not a "new fad," but is here to stay.

One of our plastic surgeons and orthodontists trained with Drs. Grayson and Cutting in New York, and we have been performing nasoalveolar molding at Children's in Seattle since 2001. Our plastic surgeons use the specific surgical techniques designed for patients after molding.

An average of six children are undergoing NAM at Children's at any time.

How does nasoalveolar molding or NAM work?

To start NAM, parents work with an orthodontist. Within the first couple of weeks after birth, babies are fitted with a custom-made molding plate that looks like an orthodontic retainer. The device is attached with a small orthodontic rubberband that is taped to the baby's face.

The molding plate causes no pain and after the first few days the plate usually doesn't bother babies at all; it's an accepted part of their face.

Unlike some older techniques, the molding plate does not push or stretch the delicate tissues; it only helps gently direct the growth of the gums.

The baby wears the molding plate 24 hours day, seven days a week, including when they are feeding. The parents change the tape and clean the molding plate daily as needed.

After the baby has worn the molding plate for a week, the orthodontist slowly adjusts the shape by sculpturing the plastic. Each adjustment is very small, but it starts to guide the baby's gums as they are growing.

Adjustment of the molding plate is done by the orthodontist weekly or every other week depending on progress. Each appointment takes 40-60 minutes.

Once the cleft gap in the gums is small enough (around one quarter-inch), a post is attached to the molding plate and is inserted in the nostril. This post is then slowly adjusted to lift up the nose and open the nostril.

By the time of the surgery, the nose has been lifted and narrowed, the gap in the gums is smaller and the lips are closer together.

A smaller gap means less tension when the surgeon closes the cleft. In our experience this results in a better final result than if NAM had not been done.

What is nasoalveolar molding or NAM?

Nasoalveolar molding is a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and palate surgery, lessening the severity of the cleft. Surgery is performed after the molding is complete, approximately three to six months after birth.

NAM is used mainly for children with large clefts and has revolutionized cleft repair.

In the past, fixing a large cleft required multiple surgeries between birth and age 18, putting the child at risk for psychological and social adjustment problems.

The first procedure pulled the lip together, a second improved the position of the lip, another two would be for the nose, then another — often including a bone graft — would close the palate, and so on.

With nasoalveolar molding, the orthodontist and surgeon can improve a large cleft in the months before surgery. This helps the surgeon get a better shape of the nose and a thinner scar in only one surgery.

A better result in the first surgery means fewer surgeries later in childhood.

Cavity Fillings

Cavity fillings are biocompatible material used for filling up the cavities, which are intentionally cut on the infected part of the tooth surface. These cavities are prepared in a scientific and a principled manner in order to achieve a strong and a long lasting filling.

The main idea of preparing a cavity is to remove the infected position of the tooth so as to prevent the further spread of decay and hence the ultimate loss of the tooth.

The cavities are prepared using high speed drilling equipment, which is controlled by the dentist. Patient may not have any discomfort initially but as the drill bit move closer to the center of the tooth (where the nerves are located), the patient begins to experience sensitivity. This can be avoided if tooth is anesthetized, which of course means having to take an injection

If the cavity prepared is very deep, a layer of medicated cement is used to line the floor of the cavity to help in healing of the tissue.

In case of metal based filling material a base is given. This base is nothing but a thick coat of cement lining the floor of the cavity. The base not only adds to the strength of the over lying filling but also insulates the tooth from sharp variation in temperature, caused by the increased thermal conductivity of the metal filling.

The term cement, which is frequently used, is a mix of a chemical powder and liquid. This mix, which is initially soft, turns hard over a period of time resembling the common cement used for construction

For cavity preparation, which is not very deep, a cement base may not be required.

Myths : Thumb sucking by children leads to forward placement of upper teeth .

Thumb sucking is a normal infant habit, which makes the child feel secure and happy. It usually decreases after the age of 3 years. However, if the habit persists beyond the age of 4-5 years it can cause problems of the teeth including forward placement of the teeth. In these children, depending upon the frequency and severity of the habit an intervention of the habit by a dental surgeon may be required.