Nasoalveolar Molding in Cleft Care—Experience in 40 Patients from a Single Centre in Germany

Abstract

Nasoalveolar molding (NAM) has gained wide acceptance and evidence in cleft therapy. However, standardized treatment protocols and experiences recorded from European centres are lacking. The results of 40 infants with cleft lip and palate treated with presurgical NAM according to the Grayson technique were analyzed. Standardized parameters of cleft width and nasal symmetry were measured in pre- and posttreatment plaster casts and in digitalized 3-dimensional STL models. Statistical analyses were performed by using Student´s t-test in a per-protocol manner. 27 out of 40 infants completed NAM and were analyzed. In 13 patients NAM was either temporarily interrupted or terminated prematurely due to skin irritations or lack of parental support. These cases were excluded from statistical analysis, resulting in a drop-out rate of 32.5%. Intersegmental alveolar distance (ISAD), intersegmental lip distance (ISLD), nostril height (NH), nostril width (NW) and columella deviation angle (CDA) were significantly changed in unilateral cleft lip and palate (UCLP) (n = 8). In unilateral cleft lip (UCL) (n = 9), only ISLD, NH and CDA were significantly changed. ISAD of the right and left side, ISLD of the right and left side, premaxilla deviation angle, nostril height and columella length were changed significantly in bilateral cleft lip and palate (BCLP) cases (n = 10). NAM is a suitable presurgical treatment modality. A positive effect has been seen in UCLP and BCLP infants, as compared with their birth status.

Effect of Cad/Cam Nasoalveolar Molding Appliance on Correction of the Nasal Deformity in Complete Bilateral Cleft Lip and Palate

“…The significant increase in columellar length indicates the high value of nasal stents in stretching of the deficient columella superiorly. The results of the study are consistent with Spengler et al (14), Lee et al (19), Punga & Sharma (17) and Rau et al (18).…”

“…In the year 2015, Rau et al performed a study to evaluate the nasal measurements before and after NAM treatment. They found a significant elongation of the columella with improvement of nasal symmetry in BCLP, thus reducing tissue tension and improving surgical outcomes (18). These results were similar to those obtained by Lee et al in the year 2008 (19).…”

Clinical application of customized presurgical nasoalveolar molding for the treatment of unilateral complete cleft lip and alveolus: case report

“…According to the present case report, the used customized PNAM method is a simple and low-cost therapy, which can minimize the need for surgical columellar reconstruction (9), with similar outcomes to more sophisticated PNAM treatments (15) and even better than others (16). Therefore, with its application a lower amount of dissection of the cartilaginous tissue may be necessary.…”

Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study

“…The cost of a medium quality IOS, ranging from 15000 to 30000 EUR, is surely not comparable with the pure cost of classical impression materials and trays used during a T&P protocol, but, considering that the use of IOS diffusion is rapidly increasing because they can be used in several fields, the cost-per-single use is gradually decreasing, in direct proportion with use. Furthermore, digitally simulating progressive changes in cleft anatomy make it possible to prepare the entire set of molding plates in advance, reducing the need for frequent visits for plate adjustments [53,54]. Nevertheless, the intraoral scanning process, with no risk of impression material inhalation, can be performed without patient transportation to the dental clinic, if a portable IOS is used.…”