The role of Nasoalveolar molding: A 3D Prospective analysis

Abstract

Nasoalveolar molding (NAM) is commonly employed to reduce the alveolar segments into proper alignment and to improve nasal symmetry in patients with cleft lip and palate. This study examines the periodical progression of NAM treatment over time. 20 patients with complete unilateral cleft lip and palate were prospectively recruited. A 2 stage NAM treatment protocol was applied. Stage 1 involved adjustment of the alveolar segments (mean age 15.6 days), while Stage 2 added nasal stents and started average 43 days after stage 1. 3D images (n = 241) were obtained prior to NAM initiation and weekly until the end of treatment. The cleft lip area, bilateral nostril areas, and the nostril height and width were measured. Treatment was assessed in the Cleft (C) side and the Non-cleft (N). There was significant difference in the C/N ratio of the nostril area, width, and height at pre-treatment (0.9 ± 0.3, 4.1 ± 1.1, and 0.5 ± 0.2), at the end of stage 1 (1.1 ± 0.3, 2.2 ± 0.6, and 0.8 ± 0.2), and at the end of stage 2 treatment (1.8 ± 0.3, 1.8 ± 0.4, and 1.2 ± 0.1); p < 0.05. Comparative 3D analysis with dense sampling offers a precise methodology for showing effects of NAM treatment. The morphological changes achieved with NAM therapy occur in early treatment phase.

Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability

“…The change in nostril height on the noncleft side was significant but that on the cleft side was highly significant. Chou et al (2017) also noted a significant improvement in the nostril height throughout the PNAM treatment but a limited increase in the nostril height on the noncleft side.…”

A semi-automated virtual workflow solution for the design and production of intraoral molding plates using additive manufacturing: the first clinical results of a pilot-study

“…It starts with the insertion of the first drinking plate, which is adjusted according to the alveolar development and extended with a nasal stent during the course of treatment. The early phase of treatment seems determining 1 . NAM is completed when primary closure of the lip is performed surgically 2 .…”

Facilitating CAD/CAM nasoalveolar molding therapy with a novel click-in system for nasal stents ensuring a quick and user-friendly chairside nasal stent exchange

“…However, the overall results and trends were comparable with the outcomes of other studies. This indicates that the aims of nasoalveolar molding, namely the improvement of nasal symmetry, columella elongation, increasing of nostril height on the cleft side and raising the columella angle, have all been achieved 23 – 25 . The additional correction of nasal symmetry will be increased again when surgical lip closure is performed.…”