Presurgical Orthopedic Intervention Prior to Cleft Lip and Palate Repair: Nasoalveolar Molding Versus Passive Molding Appliance Therapy

Abstract

Background: Nasoalveolar molding (NAM) is a widely used presurgical orthopedic device, despite disputes over its effectiveness. This study compares the outcomes after cleft lip and nose repair in patients who received NAM versus those who underwent passive alveolar molding with lip taping. Methods: A retrospective review of patients with complete unilateral cleft lip and palate who received either NAM (n = 16) or passive molding (n = 10) treatments was conducted. Alveolar gap width was measured on maxillary casts until time of palatoplasty. Nasolabial symmetry was assessed by examining anthropometric ratios on post-operative three-dimensional photographs. Burden of care was evaluated by analyzing the number of patient appointments attended, treatment costs, and caregiver satisfaction surveys. Results: No statistically significant difference existed in alveolar gap at time of initial appointment or palatoplasty, however the gap was smaller in the NAM cohort at time of lip and nose repair. No statistically significant difference existed in postsurgical heminasal width, nostril width, nostril height, labial height or nasal ala projection asymmetry between the NAM and the passive molding cohort. Patients in the NAM group attended more dental appointments and incurred higher treatment costs compared to the passive molding group. Caregivers reported high satisfaction with treatment outcomes in both cohorts. Conclusions: There were no differences between NAM and passive molding regarding postsurgical nasolabial appearance and patient satisfaction. Both treatments narrow the alveolar gap. However, NAM places a higher burden of care on families.

A Point-of-Care Digital Workflow for 3D Printed Passive Presurgical Orthopedic Plates in Cleft Care

“…In contrast, nasoalveolar molding has been criticized for the high treatment burden, visits, and thus healthcare costs [ 30 ]. It was shown that these costs could be reduced with passive presurgical treatment [ 31 ]. This could also counteract early cleft lip surgery in the first weeks of life, which has been propagated to reduce the burden of health care costs [ 32 ].…”

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

“…Lip taping is offered by 53% of survey respondents in our study, and maybe the preferred modality for certain patients due to the aforementioned criteria. While the results of lip taping may be suboptimal compared with NAM, the alveolar cleft gap is still reduced with its employment 41. Compared with no PSIO therapy, lip taping efficiently changes the maxillary arch dimension using passive lip pressure, thus facilitating a lip repair procedure with reduced tension 42.…”

“…While the results of lip taping may be suboptimal compared with NAM, the alveolar cleft gap is still reduced with its employment. 41 Compared with no PSIO therapy, lip taping efficiently changes the maxillary arch dimension using passive lip pressure, thus facilitating a lip repair procedure with reduced tension. 42 If the surgeon intends to perform a gingivoperiosteoplasty and requires that segments abut, the modality of choice would still be NAM.…”

Manejo ortopédico prequirúrgico de labio y paladar hendido unilateral: Reporte de casos con diferentes abordajes

“…La terapia prequirúrgica debe iniciar idealmente al momento del nacimiento [3][4][5]9 . En países de recursos limitados, la atención temprana y oportuna se dificulta debido a que los centros de referencia para la atención multidisciplinaria de estos pacientes son escasos.…”

“…En la última década distintas técnicas han sido utilizadas por varios centros multidisciplinarios alrededor del mundo con este fin. 3,4 El propósito común de la técnica de Ortopedia Funcional Maxilar (OFM)-Moldeado Nasal (MN), descrita por Pannaci 5 y el Retractor nasal (RN)-Taping modificación Hinostroza 6 en pacientes con LPHU es disminuir la amplitud de la brecha alveolar y palatina y moldear el cartílago alar del lado afectado para reducir la necesidad de disecciones mayores con la consecuente tensión en el labio superior ya reparado. La diferencia entra ambas técnicas es la placa OFM, que no se usa en la técnica RN-Taping.…”