Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review

Abstract

ObjectivesThe authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair.Material and MethodsA literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals (“Cleft Palate-Craniofacial Journal”, “Plastic and Reconstructive Surgery Journal” and “American Journal of Orthodontics and Dentofacial Orthopaedic”) from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology.ResultsOf the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking.ConclusionsBased on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.

Quantitative Evaluation of Nasolabial Alterations following Nasoalveolar Molding (NAM) Therapy in Patients with Unilateral Cleft Lip

“…3 Studies that have evaluated NAM, to date, have consistently demonstrated that it has a positive effect on nasolabial aesthetic outcomes. 4,5 NAM has been associated with improved ratings of both predicted and actual surgical outcomes following primary repair. 6,7 NAM has also been associated with decreased rates of secondary revision, 8,9 leading to reductions in total cost of care.…”

“…Barriers to the systematic review and meta-analysis of NAM studies include heterogeneity in technique, appliances, and outcome measures; differences in study design and baseline patient characteristics; and inadequate sample sizes. 4,5 Hence, there continues to be active debate regarding its value. 11,12 This has motivated recent calls for more rigorous description of the study design and better standardization of quantitative outcome measurements in future studies evaluating NAM.…”

The Surgical Nasoalveolar Molding: A Rational Treatment for Unilateral Cleft Lip Nose Deformity and Literature Review

“… 33 , 34 A 2017 meta-analysis by Hosseini et al 34 suggested further research to reach more relevant recommendations. Two recent reviews by Maillard et al 35 in 2017 and Liu et al 36 in 2018 concluded that the use of NAM offers positive aesthetical effects. This conclusion cannot be drawn from the present work due to the heterogeneity of the included studies and nonspecificity of the research questions.…”

Controversies in Cleft Rhinoplasty

“…18 Systematic reviews are equivocal on the effectiveness of NAM. Proponents 19 and opponents 20,21 have failed to reach a consensus, partially due to protocol and technical differences among institutions. Other factors involve the differences in baseline patient characteristics, limited number of high-level studies, and lack of clear objective outcome measures.…”