Nasal Changes after Presurgical Nasoalveolar Molding (PNAM) in the Unilateral Cleft Lip Nose

Gomez, David F.; Donohue, Sean T.; Figueroa, Álvaro A.; Polley, John W.

doi:10.1597/11-007

Cited by 51 publications

(48 citation statements)

References 42 publications

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“…A growing number of cleft centers now offer NAM [5] and research has reported on the benefits of NAM or a similar variation of presurgical orthopedics [6, 7]. For example, patients with unilateral cleft lip who undergo NAM reportedly demonstrate greater nasal symmetry through 9 years of age than patients with unilateral cleft lip who do not have NAM [8].…”

Section: Introductionmentioning

confidence: 99%

Surgeon’s and Caregivers’ Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

Broder

Flores

Clouston

et al. 2016

Plastic and Reconstructive Surgery

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Background Despite the increasing use of nasoalveolar molding (NAM) in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without NAM in a non-randomized, prospective multicenter study. Methods Participants were 110 infants with cleft lip/palate (62 treated with NAM and 48 treated without NAM (NO-NAM)) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photos for a randomized subset of 54 infants were rated pre-treatment and post-surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photos included frontal, basal, left and right views of the infants. Using the same scale, caregivers rated their infants’ lip, nose, and facial appearance compared to the general population of infants without clefts pre-treatment and post-surgery. Multilevel modeling was used to model change in ratings of infants’ appearance pre-treatment and post-surgery. Results The expert clinician ratings indicated that NAM-treated infants had more severe clefts at pre-treatment; yet both groups were rated equally post-surgery. NAM caregivers reported better post-surgery outcomes compared to NO-NAM caregivers (p<0.05), particularly in relation to the appearance of the nose. Conclusions Despite having a more severe cleft before treatment, infants who underwent NAM were found by clinician ratings to have comparable results to those who underwent lip repair alone. Infants who underwent NAM were perceived by caregivers to have better treatment outcomes than those that underwent lip repair without NAM.

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Section: Introductionmentioning

confidence: 99%

Surgeon’s and Caregivers’ Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

Broder

Flores

Clouston

et al. 2016

Plastic and Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7][8][9][10][11] In this study, both techniques effectively reduced alveolar gap and effectively improved nasal symmetry. This improvement was mainly vertical (percentage change in nostril height ratio: 38.4 and 37.9 for the Grayson and Figueroa techniques, respectively; p ϭ 0.916) (Figs.…”

Section: Discussionmentioning

confidence: 91%

Comparative Outcomes of Two Nasoalveolar Molding Techniques for Unilateral Cleft Nose Deformity

Liao

Hsieh

Chen

et al. 2012

Plastic and Reconstructive Surgery

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“…Among the group of studies that assesses only the nasal molding, 2 studies were included. These reported an improvement of nasal symmetry and alar cartilage depression with NAM before primary surgeries [ 45 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

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

Maillard

Retrouvey

Ahmed

et al. 2017

JOMR

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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.

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Nasal Changes after Presurgical Nasoalveolar Molding (PNAM) in the Unilateral Cleft Lip Nose

Abstract: A favorable reshaping of the nose after PNAM was achieved, resulting in an improvement in form before lip surgery. These changes lead to improved nasal symmetry before primary lip and nasal reconstruction in UCLP patients.

Cited by 51 publications

References 42 publications

Surgeon’s and Caregivers’ Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

Surgeon’s and Caregivers’ Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

Comparative Outcomes of Two Nasoalveolar Molding Techniques for Unilateral Cleft Nose Deformity

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

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