Nasoalveolar Molding and Gingivoperiosteoplasty versus Alveolar Bone Graft: An outcome Analysis of Costs in the Treatment of Unilateral Cleft Alveolus

Abstract

Objective The purpose of this study was to compare the financial impact of two treatment approaches to the unilateral cleft alveolus. The recently advocated nasoalveolar molding (NAM; Grayson et al., 1999) and gingivoperiosteoplasty (GPP; Santiago et al., 1998) at the time of lip repair were compared with the traditional approach of secondary alveolar bone graft. Design The records of all patients (n = 30) with unilateral cleft lip and alveolus treated by a single surgeon during 1985 through 1988 were examined retrospectively. The patients were divided into two groups: group 1 patients (n = 14) were treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition; group 2 patients (n = 16) were treated by NAM, GPP, lip repair, and primary nasal repair. Patients who required secondary alveolar bone graft after GPP were noted. The cost of treatment by each protocol was calculated in 1998 dollars. Results The average cost of treatment for a patient treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition was $22,744. Of the 16 patients treated by NAM, GPP, lip repair, and primary nasal repair, 10 required no further treatment of the unilateral cleft alveolus; six patients required secondary alveolar bone graft. The average per-patient treatment cost in this group was $19,745. The average cost savings of NAM and GPP, compared with alveolar bone graft is $2999. Conclusions The treatment of unilateral cleft alveolus by nasoalveolar molding and gingivoperiosteoplasty results in substantial cost savings, compared with treatment by secondary alveolar bone graft.

Nasoalveolar Molding and Long-Term Postsurgical Esthetics for Unilateral Cleft Lip/Palate: 5-Year Follow-Up

“…Reduced need for alveolar bone grafting by NAM has been suggested by some authors. 11,12 In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. 13 Thus, NAM frequently simplifies surgeons' reconstruction in cleft lip and palate.…”

Three‐dimensional facial morphology following surgical repair of unilateral cleft lip and palate in patients after nasoalveolar molding

“…Later, Pfeifer et al . (7) suggested that the combination of NAM and gingivoperiosteoplasty is more cost‐effective when compared with treatments involving secondary alveolar bone grafts.…”

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

“…6,7 NAM has also been associated with decreased rates of secondary revision, 8,9 leading to reductions in total cost of care. 10 However, despite its increasingly widespread use, the efficacy of NAM has thus far been difficult to evaluate. 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.…”