Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire-bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.
Two cases of hypoglossia congenita with anterior maxillo-mandibular fusion are reported. One is a case of hypoglossia with anterior maxillo-mandibular fusion and the other is a case of hypoglossia-hypodactylia with anterior maxillo-mandibular fusion. This condition presents the anaesthetist with the problem of airway management during the surgery. A simple technique using a nasopharyngeal tube was used for these two cases, with satisfactory results.