Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of this systematic review and meta-analysis was to investigate long-term treatment effects of nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate (UCLP). Design: Included manuscripts met the following criteria: (1) involved patients with UCLP who received NAM; (2) included comparison group(s) who either received non-NAM passive presurgical infant orthopedic appliances (PSIO) or who did not receive any PSIO; (3) reported at least one objective or validated measure of nasolabial, craniofacial, or palatal form; and (4) had patient follow-up beyond 4 years of age. Results: A total of 12 studies were included in this review. Meta-analyses were possible for Asher-McDade parameters and cephalometric measurements. Compared to patients who did not receive any PSIO, those who underwent NAM therapy were more likely to have good to excellent frontal nasal form (Risk ratio: 2.4, 95% CI: 1.24-3.68) and vermillion border (Risk ratio: 1.8, 95% CI: 1.19-2.71). However, there were no statistically significant differences in cephalometric measurements between these groups. Additionally, there were no statistically significant differences between patients receiving NAM versus non-NAM PSIO. There was insufficient evidence to determine the impact of NAM on dental arch development. Conclusions: The preponderance of evidence in this review suggests that NAM produces benefits in nasolabial aesthetic form when compared with no appliance-based presurgical treatment. However, there is insufficient evidence to conclude whether NAM produces such benefits when compared with other passive PSIOs.

Evaluation of Facial Esthetics Following NAM Versus CAD/NAM in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial

“…In brief, the results of the present work substantiate the recent evidence reporting the benefits of adopting NAM treatment prior to lip surgery to achieve favorable outcomes in the nasolabial form and nasal profile in patients with CLP. 4 Additionally, the effectiveness of the CAD/NAM modality on the nasolabial esthetics before the lip surgery was proved to be similar to the conventional NAM methods. Other factors such as the chairside time, the number of follow-up visits, the overall cost analysis, and the availability of the equipment needed are also important points to be considered while comparing both modalities.…”

Presurgical techniques for the treatment of cleft lip and palate in infants – a review of the literature

“…A study on the effectiveness of using PSO techniques with the NAM technique was described by Padovano et al [27], who reviewed 12 studies on the long-term effects of using this technique in patients with unilateral cleft lip and palate. According to the analysis of the data, the use of the NAM technique was found to be beneficial in improving the aesthetic aspect compared to no presurgical treatment with braces [27]. According to Maull et al [28], the NAM technique has a beneficial effect on nasal shape in patients with unilateral complete cleft.…”

Multidisciplinary treatment from infancy to adolescence of a patient with a unilateral cleft lip and palate: a 16-year follow-up case report

“…27,28 The present case report demonstrates that presurgical maxillary orthopaedic treatment performed in accordance with NAM procedures, together with a longterm review, produces positive treatment results. 29,30 Although the encouraging effects of NAM in patients affected by a unilateral cleft lip and palate (UCLP) have been described by Padovano et al, 30 the long-term effects of the procedure are unclear. The additional care burden and frequent appointments create challenges, and alternative procedures such as DynaCleft (Southmedic, Ontario, Canada) have been established when traditional presurgical orthopaedic treatment is inappropriate.…”