Challenges encountered while treating cleft lip and palate cases using Pre surgical Naso alveolar Moulding (PNAM) during covid 19 pandemic

Presurgical Naso Alveolar Moulding (PNAM) is a non surgical method of shaping the alveolus and palatal processes as well as the lip in bilateral and unilateral cleft lip and palate cases. From the introduction of a passive appliance by Gotz to an active Latham appliance to a semi passive Grayson appliance, the techniques have been under constant evolution. Early intervention reduces the severity of the defect but also enhances the aesthetic outcome by not only minimising the defect by moulding the alveolus and approximating the lips but also elongating the collumella and replicating the nostril dimensions. However although PNAM has shown definitive benefit, there is no conclusive evidence drawn due to heterogenecity of studies. the main reason for this being the challenges faced during treating such cases. This paper aims to highlight and discuss the challenges faced during treating cleft lip and palate cases in the Department of Prosthodontics during the pandemic.