The Nasoalveolar Molding Cleft Protocol: Long-Term Treatment Outcomes from Birth to Facial Maturity

Abstract

left lip and palate are the most common congenital anomaly of the face. Although the optimal indications and treatment protocols continue to be debated, one of the most actively discussed therapies is nasoalveolar molding. [1][2][3] Supporters of nasoalveolar molding cite statistically significant improvements in nasal symmetry in patients who undergo the treatment compared with those who do not, 4,5 benefit to nasal aesthetics as judged by caregivers and surgeons, 6,7 greater benefit to columellar length in patients with bilateral cleft lip, 8-10 cost benefit compared with lip adhesion, 11 decreased need for revision surgery on the nose, 9,12 psychosocial benefit to caregivers, 6,7 and the opportunity for primary alveolar reconstruction in the form of gingivoperiosteoplasty, which can avoid secondary alveolar bone

Profiling Gingivoperiosteoplasty (GPP): A Cross-Sectional Analysis Using a Nationally Validated Pediatric Surgery Database

“…It has been shown to obviate the need for secondary bone graft in as high as 72% of patients, does not significantly limit facial bone development, and has a low incidence of cleft lip and nasal revision. 11,18,25 This study was limited to short term surgical outcomes and demonstrated that addition of GPP to cleft lip repair did not increase post-operative complications or 30-day readmission when compared to cleft lip repair alone.…”

“…It is notable that many of the leading cleft centers performing NAM complete presurgical infant orthopedics within 3 months in a patient with a unilateral cleft and 5 months in a patient with a bilateral cleft. 10,17-19…”

“…It is notable that many of the leading cleft centers performing NAM complete presurgical infant orthopedics within 3 months in a patient with a unilateral cleft and 5 months in a patient with a bilateral cleft. 10,[17][18][19] The data currently available on GPP are related to long term outcomes with regards to 3 major end points: need for secondary bone graft at time of mixed dentition, complications related to facial bone growth, and need for secondary procedures. These outcomes have been analyzed in patients undergoing GPP without PSIO, with Latham PSIO, and with NAM.…”

Inverted V-Y and fibrofatty Flap technique for columellar lengthening and tip augmentation in adults post bilateral cleft lip nasal deformity

“…Every day there are many ideas and innovations regarding precise job in rhinoplasty, 21 aesthetic surgery 22 and reconstructive surgery. 23,24 That includes nasal reconstruction, 23 cleft lip and palate nasal deformity 25 regarding appearance, 26 function, respiratory problems 27 and skeletal maturation 28 which are still points of research that shows a flow of ideas and innovations.…”

“Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding and Gingivoperiosteoplasty from Birth to Facial Maturity”

“…20 Previous studies of patients with UCLP suggest that NAM does not significantly affect facially mature cephalometric measures for midface growth. 21 However, the effect of NAM on maxillomandibular proportions for patients with BCLP has not been evaluated with cephalometric analysis spanning from birth to facial maturity.…”