A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate

Abstract

urgical treatment of the unilateral cleft lip nasal deformity is complex and remains a significant challenge. Nasoalveolar molding before primary cleft lip repair is an adjunct that has evolved from presurgical infant orthopedics for alignment of the alveolar segments, to nasoalveolar molding, which also molds the nasal framework. Although nasoalveolar molding has been widely adopted by many North American centers, 1,2 the literature regarding outcomes has been contradictory, and its use continues to be debated. [2][3][4][5][6] Studies have demonstrated favorable changes before and after nasoalveolar molding 7-12 and immediately after surgery [13][14][15] ; however, what is not clear is whether these changes are long lasting or

The Yin and Yang of Primary Unilateral Cleft Lip and Nose Repair: Balance through understanding the opposing cleft and non-cleft side changes

“…46 Although presurgical molding is helpful, a focus on tissue expansion and columellar morphology could lead to overexpansion of the nose, resulting in an iatrogenic meganostril. As revealed in our previous audit, 47 improved convexity of the cleft heminasal tip and reduction of nostril rim recurvatum produce the most favorable outcomes following surgical repair and should be the goals of presurgical molding.…”

Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM)

“…The majority of papers (44/87, 50.6%) were confirmed to use unmodified Grayson-Santiago NAM or a minor variation that would be expected to perform similarly to unmodified Grayson-Santiago NAM according to the specific outcomes considered by this review. 20–50 Such acceptable variations included subtleties of device structure or minor changes to the timing of device modifications. 51–62 Many papers (28/87, 32.2%) did not specify the NAM technique that was employed and did not offer an adequate picture of the device or description of the protocol to be appraised.…”

“…Of these, 38 studies (62.3%) quantified this outcome using indirect anthromorphometry. 22 Indirect anthropometric measurements were taken from 2D photographs, [22][23][24]27,29,32,33,35,37,[56][57][58][59][60]62,64,75,76,79,80,82,84,[87][88][89]100,104,106 3D stereophotographs, 20,26,45,46,65,72,77,78,86 nasal casts, 25,30,31,44,47,48(p199), 51,52,54,55,67,105 and 3D scans taken of the facial casts. 105 Few studies (4/61, 6.6%) reported direct anthromorphometry, measured directly from the patient's face while under anesthesia.…”

Updates in Cleft Care

“…23,24,56,57 However, the prostheses can be uncomfortable for the patient, and the additional appointments, expense, and risk of skin breakdown can limit compliance with this approach. 58 In patients with wide clefts that do not correct with nasoalveolar molding, surgical lip adhesion can be considered to narrow the cleft size before definitive surgical correction. 23,59 Surgical intervention for CL/P begins by correction of lip and nasal defects, followed by palatoplasty.…”