Comparative Photographic, Retrospective Analysis of Nonsyndromic Cleft Noses Treated with or without NAM

Abstract

Background: Long-term results and efficacy of nasoalveolar molding (NAM) on the perinasal region are reported controversially in the literature. With this study, we demonstrate our experiences, contribute to the ongoing discussion, and describe our decision-making when NAM is indicated or not. Methods: Conventional pre- and postinterventional photographs of patients with nonsyndromic unilateral and bilateral cleft lip and palate (UCLP and BCLP) were analyzed. The 2 independent raters were blinded to therapy (NAM versus non-NAM), and 7 parameters were measured. Intraclass correlation coefficient for intra- and interrater reliability was calculated. The Mann–Whitney U test was performed to compare therapy- and appearance-matched pairs. Finally, 30 specialists in cranio-maxillofacial surgery performed a subjective, blinded rating of matched NAM and non-NAM cases. Results: Thirty-six patients, 16 UCLP and 20 BCLP, were enrolled. The intraclass correlation coefficients for intra- and interrater reliability were excellent for all measurements, except for nasal sill (0.77 intrarater and 0.80 interrater). Height-to-width ratio (P = 0.012) was significantly different in the comparison of non-NAM and NAM-treated severe cases with UCLP. Thirty blinded raters evaluated NAM-treated cases with severe UCLP better than matched non-NAM cases. Non-NAM-treated cases with moderate UCLP and BCLP were rated better than matched NAM cases. Conclusions: Children with severe UCLP may benefit from NAM therapy in the sense of better symmetry and a more homogenous appearance. Patients with moderate UCLP and BCLP did not benefit, and the risk of the burden of care increased.

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

“…All measurements were performed independently by two investigators (PK and FDG). All analyses were performed twice; the second round of analysis was performed at least seven to fourteen days later to minimize a habitual landmark setting and six-point alignment (26).…”

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

“…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. 33,63–94 The remaining papers (15/87, 17.2%) used a technique that varied so critically from Grayson-Santiago NAM that an argument can be made that these were a different type of PSIO rather than a form of NAM. Such critical variations included inadequate retention of the device 93,95,96 and significantly different structure of the nasal component.…”

“…The most common comparator was non-treatment (ie, patients with CL ± A ± P who did not receive any NAM or PSIO). 24,26,30–34,36,38,62,65,67,69,76,79–84,88–90,92,94,95,100,101 The absence of NAM/PSIO was sometimes, but not always, compensated for by a different surgical technique or protocol. 35,57,85,100 The second most common comparator was age-matched, non-clefted children, as a representation of “normal” anatomy.…”

“…Of these, 38 studies (62.3%) quantified this outcome using indirect anthromorphometry. 22–27,29,31,32,35,37,44,47,49,51–55,57–60,64,68,72,75,76,78,79,82,86–88,100,104–106 Indirect anthropometric measurements were taken from 2D photographs, 22–24,27,29,32,33,35,37,56–60,62,64,75,76,79,80,82,84,87–89,100,104,106 3D stereophotographs, 20,26,45,46,…”

“…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.…”