A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

Abstract

Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.

The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft

“…The idea of using presurgical orthopedics is to improve the symmetry of the upper arch 5 and enhance the symmetry of the immature nasal cartilage through nasal stents before the primary surgery. 10,30 In this context, the evaluation of the changes that the NAM protocol promotes, or the consequences of its absence, in nasal and maxillary symmetry seeks to confirm its importance, providing evidence for choosing the best treatment available for the child with a cleft. This study found that the treatment with NAM through the reverse engineering technique yielded maxillary and facial growth effects towards better symmetry in patients with complete UCL/P.…”

“…Since the 1950s, different techniques have been presented to bring soft and hard tissue closer together 3,4 . The nasoalveolar molding (NAM) technique is a treatment modality described by Grayson et al, 5 which seeks to alleviate asymmetries and cleft severity before surgery 6–8 while promoting important modifications on immature nasal cartilage, taking advantage of its malleability 9,10 …”

“…The diversity of study models, evaluation times, size and heterogeneity of the samples, different protocols performed, and poorly detailed descriptions of the methods make it difficult to safely evaluate studies that use the NAM protocol 13 . Among the methods used by studies to assess the effects of NAM therapy are the use of 2-dimensional images, 7,10,14,16,17 and even 3-dimensional records 18–24 . Results of the studies have shown improvement in the aesthetics of the nose, lip, alveolar bone, palate, and nasal wings 14 .…”

Nasoalveolar molding: benefits and burdens

“…Assessing nasolabial aesthetics in BCLP patients using the anatomic subunit scale, we found that the immediate (6-month) aesthetic results were significantly better in those who had nasoalveolar molding [44] . Unfortunately, this was not a randomized study, and there was no power calculation to determine the sample size.…”

“…The literature suggests relapse is apparent in the first postoperative years [43][44][45] . Practitioners believe that primary rhinoplasty is warranted as an adjunct to NAM.…”