Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate

Kornbluth, Michelle; Campbell, Richard E.; Daskalogiannakis, John; Ross, Elizabeth; Glick, Patricia; Russell, Kathy; Doucet, Jean-Charles; Hathaway, Ronald; Long, Ross E.; Sitzman, Thomas J.

doi:10.1177/1055665618757367

Cited by 34 publications

(57 citation statements)

References 35 publications

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“…Nasoalveolar molding-treated patients were found to have a comparable outcomes to non-NAM-treated patients from the same treatment center as well as from 2 other treatment centers, but worse outcomes than non-NAM-treated patients from a third center. Due to multiple differences in treatment protocols, the cause of these growth differences could not be determined (Kornbluth et al, 2018). Despite these difficulties, numerous published studies have detected no adverse effects in NAM-treated patients.…”

Section: Abstract Nonsyndromic Clefting Infant Orthopedics Facial Gmentioning

confidence: 99%

“…Published evidence shows that NAM-treated patients demonstrated improved anthropometric measures such as nasal tip projection (Peanchitlertkajorn et al, 2018) and nasal symmetry (unilateral cleft lip and palate [UCLP]; Barillas et al, 2009; Chou et al, 2017) and improved columellar length (Lee et al, 2008) and normalize nasal morphology (bilateral cleft lip and palate [BCLP]; Garfinkle et al, 2011; Meazzini et al, 2018). In addition to these objective differences, NAM treatment is also associated with subjective improvements in nasal aesthetics (Chang et al, 2010; Kornbluth et al, 2018).…”

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confidence: 99%

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NAM Therapy—Evidence-Based Results

Esenlik

Gibson

Kassam

et al. 2020

The Cleft Palate-Craniofacial Journal

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Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

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Section: Abstract Nonsyndromic Clefting Infant Orthopedics Facial Gmentioning

confidence: 99%

mentioning

confidence: 99%

NAM Therapy—Evidence-Based Results

Esenlik

Gibson

Kassam

et al. 2020

The Cleft Palate-Craniofacial Journal

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“…Nasoalveolar molding is a nonsurgical treatment performed during the first 3 to 5 months after birth, which utilizes an orthopedic appliance to reposition distorted alveolar segments, improve the shape of nasal cartilages, and enlarge or elongate relevant soft tissue structures to facilitate surgical repair. Nasoalveolar molding has been demonstrated to improve objective measures of nasal symmetry and morphology (Bennun et al, 1999; Barillas et al, 2009; Peanchitlertkajorn et al, 2018), improve subjective nasal aesthetics (Kornbluth et al, 2018), and to nearly eliminate the need for surgical nasal revisions in unilateral cleft lip and palate (Lee et al, 2008; Patel et al, 2015). In many cases, NAM may also facilitate the performance of gingivoperiosteoplasty (GPP) at the time of lip repair, which eliminates the need for future alveolar bone grafting in 60% to 75% of cleft sites (Santiago et al, 1998; Sato et al, 2008; Wang et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic Predictors of Treatment Success and Difficulty in Nasoalveolar Molding

Gibson

Grayson

Shetye

2020

The Cleft Palate-Craniofacial Journal

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Objective: To assess social and demographic influences on caregiver success and difficulty with nasoalveolar molding (NAM). Design: Retrospective review identified patients who began NAM between April 22, 2013, and April 18, 2017, at the New York University Langone Medical Center. Records were reviewed, and the following sociodemographic data retrieved: parental marital status, parental ages, number of siblings, distance traveled to clinic, insurance coverage, concurrent medical conditions, and need for an interpreter. Patients: Patients were included if complete charting was available; 106 patients met the inclusion criteria; 79 patients with unilateral and 27 with bilateral clefts. Outcome Measures: Chart entries indicating incorrect appliance usage, emergency visits, phone calls, and noncompliance were recorded. Alveolar cleft gap closure was measured on pre- and posttreatment models in unilateral cases. Multiple regression analyses were performed to assess the influence of social variables on these outcomes. Results: Alveolar cleft gap closure was 7.2 ± 3.0 mm, or 78.5% ± 19.1%. Cleft closure increased with paternal age by 0.33 mm ( P = .007) or 2.0% ( P = .017) per year, decreased with maternal age by 0.29 mm ( P = .041) per year, and increased in married and partnered parents by 39% ( P = .018). Incorrect appliance usage averaged 0.62 fewer instances for married and partnered parents ( P = .018) and 0.43 fewer for those with private insurance ( P = .019). Conclusions: Alveolar cleft gap closure was more successful for older fathers, younger mothers, and married couples. Married couples were also less likely to experience treatment difficulties such as incorrect appliance usage or inadequate duration of wear, as were those with private insurance coverage.

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“…Although nasoalveolar molding has been widely adopted by many North American centers, 1,2 the literature regarding outcomes has been contradictory, and its use continues to be debated. [2][3][4][5][6] Studies have demonstrated favorable changes before and after nasoalveolar molding 7-12 and immediately after surgery [13][14][15] ; however, what is not clear is whether these changes are long lasting or…”

mentioning

confidence: 99%

A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate

Kurnik

Çalış

Sobol

et al. 2021

Plastic &Amp; Reconstructive Surgery

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urgical treatment of the unilateral cleft lip nasal deformity is complex and remains a significant challenge. Nasoalveolar molding before primary cleft lip repair is an adjunct that has evolved from presurgical infant orthopedics for alignment of the alveolar segments, to nasoalveolar molding, which also molds the nasal framework. Although nasoalveolar molding has been widely adopted by many North American centers, 1,2 the literature regarding outcomes has been contradictory, and its use continues to be debated. [2][3][4][5][6] Studies have demonstrated favorable changes before and after nasoalveolar molding 7-12 and immediately after surgery [13][14][15] ; however, what is not clear is whether these changes are long lasting or

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Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate

Cited by 34 publications

References 35 publications

NAM Therapy—Evidence-Based Results

NAM Therapy—Evidence-Based Results

Sociodemographic Predictors of Treatment Success and Difficulty in Nasoalveolar Molding

A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate

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