A novel clinical innovation: Bilateral modified indigenous nasal elevator with calibrated force for alar dome correction in bilateral cleft lip and palate patients

Presurgical nasoalveolar molding (PNAM) is a key intervention in the management of cleft lip and palate deformities, aiming to optimize soft tissue and cartilaginous anatomy prior to surgical repair. However, conventional devices such as the Grayson nasal stent can be cumbersome, interfere with feeding, and are often poorly tolerated in bilateral cleft lip and palate (BCLP) patients. This report describes the successful use of a novel bilateral modified indigenous nasal elevator (BMINE) appliance in a neonate with BCLP. The infant, presenting with severe columellar shortening, nasal dome collapse, and a protrusive premaxilla, was managed using a phase-wise protocol: PNAM with BMINE, followed by lip repair and rhinoplasty at 3 months, and planned palatal repair at 15–18 months. The BMINE appliance, fabricated using 19-gauge stainless steel wire and heat-cure acrylic, provided patient-specific, calibrated traction to the alar domes. Its pull-type mechanism allowed columella centralization, nasal dome elevation, and effective nasal cartilage molding, without interfering with feeding or requiring invasive fixation. Over the course of treatment, the intersegmental gap reduced from 11 mm to 2.5 mm. Columellar angle improved from 115° to 91°, and nasal symmetry and alar dome projection were restored. Postoperative assessment confirmed improved nasal contour, lip esthetics, and arch form. The appliance continued to be used postoperatively, with periodic modifications to accommodate facial growth, thereby preserving surgical outcomes. The BMINE appliance offers a low-cost, customizable, and noninvasive alternative to conventional NAM techniques in BCLP patients. Its bilateral design, ease of fabrication, and calibrated force application make it a valuable adjunct for cleft teams, particularly in resource-constrained settings. Further studies are warranted to evaluate its long-term outcomes and scalability.