Current Presurgical Infant Orthopedics Practices Among American Cleft Palate Association–Approved Cleft Teams in North America

Abstract

Presurgical infant orthopedic (PSIO) therapy has evolved in both its popularity and focus of treatment since its advent. Nasoalveolar molding, nasal elevators, the Latham appliance, lip taping, and passive plates are the modern treatment options offered by cleft teams. Many cleft surgeons also employ postsurgical nasal stenting (PSNS) after the primary lip repair procedure. The purpose of this study is to examine trends in current PSIO care as well as PSNS for the management of patients with cleft lip and palate. An electronic survey was distributed to cleft team coordinators listed by the American Cleft Palate Association. The survey reported on team setting, provider availability, PSIO offerings, contraindications, and use of PSNS. Descriptive statistics and analyses were performed using MS Excel and SPSS. A total of 102 survey responses were received. The majority of settings were children’s specialty hospitals (66%) or university hospitals (27%). Presurgical infant orthopedics was offered by 86% of cleft teams, and the majority of those (68%) provided nasoalveolar molding. Nasal elevators and lip taping are offered at 44% and 53% of centers, respectively. Latham and passive plates are both offered at 5.5% of centers. Most centers had an orthodontist providing treatment. The majority of centers use PSNS (86%). Nasoalveolar molding is the most popular PSIO technique in North American cleft centers followed by the nasal elevator, suggesting that the nasal molding component of PSIO is of critical influence on current treatment practices.

Defining the Treatment Gap in Nasoalveolar Molding: Factors Affecting the Utilization of NAM in an Urban Cleft Center

“…Other institutions have reported higher rates of postsurgical stenting in patients who do not receive NAM, presumably because this population has an increased need for nasal shape retention. 6 In our experience, patients who do not undergo NAM tend to have a mild cleft deformity with a mild nasal deformity. The decision to use nostril retainers at our institution is made on postoperative week 3, after examination by the treating surgeon and orthodontist.…”

“…[1][2][3] A recent survey study reported that over half of the American Cleft Palate-Craniofacial Association (ACPA)-approved cleft teams offer some type of PSIO as part of the cleft treatment protocol, with a majority of these centers utilizing nasoalveolar molding (NAM) therapy. [4][5][6] NAM has been shown to reduce cleft severity prior to primary surgical repair, facilitate gingivoperiosteoplasty (GPP) to decrease the need for secondary alveolar bone grafting, and improve lip and nasal form. [7][8][9][10][11] However, despite reported improvements in aesthetic, functional, and psychological outcomes secondary to NAM treatment, the ease of access to and utilization of NAM has remained a topic of debate.…”

A multi-centric, single blinded, randomized, parallel group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus, and palate (NAMUC study). A study protocol for a randomized controlled trial.

“…A survey conducted in 2011 across 117 centers in the United States found that 37% of cleft teams offered NAM treatment (12). However, a subsequent survey showed that 68% of centers now provide NAM treatment (13). In India, a recent survey indicated that 25% of centers are routinely conducting NAM treatment (14).…”

A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial

“…A survey conducted in 2011 across 117 centres in the USA found that 37% of cleft teams offered NAM treatment [ 12 ]. However, a subsequent survey showed that 68% of centres now provide NAM treatment [ 13 ]. In India, a recent survey indicated that 25% of centres are routinely conducting NAM treatment [ 14 ].…”