Cleft Lip Repair, Nasoalveolar Molding, and Primary Cleft Rhinoplasty

AbstractRhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip–palate are technically and intellectually challenging to master requiring a patient-tailored approach. The shape and structure of the nose are changed to improve both function and aesthetic appearance. In the primary setting, nasoalveolar molding is a form of presurgical infant orthopaedics used for preparation before the cleft lip and nose repair. Intermediate stages should be conservative to minimize scarring, while the definitive cleft rhinoplasty utilizes cartilage grafts from septum, ear, or rib to sculpt the nose. Hereinto, we will outline the controversies, the evidence supporting certain techniques, and our preferences.

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A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate

European Journal of Dentistry ◽

10.4103/1305-7456.184146 ◽

2016 ◽

Vol 10 (03) ◽

pp. 435-438 ◽

Cited By ~ 6

Author(s):

Chitravelu Siva Subramanian ◽

N. K. K. Koteswara Prasad ◽

Arun B. Chitharanjan ◽

Eric Jein Wein Liou

Keyword(s):

Functional Outcome ◽

Surgical Procedures ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Treatment Technique ◽

Patient Needs ◽

Nasal Cartilage ◽

Primary Rhinoplasty ◽

Cleft Lip Repair ◽

Nasoalveolar Molding

ABSTRACTNasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application.

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A Comparative Cost Analysis of Cleft Lip Adhesion and Nasoalveolar Molding before Formal Cleft Lip Repair

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e31829b69fe ◽

2015 ◽

Vol 136 (6) ◽

pp. 1264-1271 ◽

Cited By ~ 14

Author(s):

Paul L. Shay ◽

Jesse A. Goldstein ◽

J. Thomas Paliga ◽

Jason Wink ◽

Oksana A. Jackson ◽

...

Keyword(s):

Cost Analysis ◽

Cleft Lip ◽

Comparative Cost ◽

Cleft Lip Repair ◽

Nasoalveolar Molding

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Clinical Practice Trends and Postoperative Outcomes in Primary Cleft Rhinoplasty

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211032196 ◽

2021 ◽

pp. 105566562110321

Author(s):

Hossein E. Jazayeri ◽

Joseph Lopez ◽

Navid Pourtaheri ◽

Kevin C. Lee ◽

Connor J. Peck ◽

...

Keyword(s):

Length Of Stay ◽

Cleft Lip ◽

Hospital Setting ◽

Predictor Variable ◽

Secondary Outcome ◽

Complication Rates ◽

Continuous Variables ◽

Linear Regression Models ◽

Cleft Rhinoplasty ◽

Cleft Lip Repair

Purpose Optimal correction of the cleft nasal deformity remains challenging. The purpose of this study was to examine the practice patterns and postoperative course of patients undergoing cleft lip repair with rhinoplasty compared to those who have primary lip repair without rhinoplasty. Methods and Materials A retrospective cohort study was conducted based on the Kids’ Inpatient Database. Data were collected from January 2000 to December 2011 and included infants aged 12 months and younger who underwent cleft lip repair. The predictor variable was the addition of rhinoplasty at primary cleft lip repair. Primary outcome variables included hospital setting, year, and admission cost, while secondary outcome variables included length of stay and postoperative complication rate. Independent t-tests and chi-squared tests were performed. Continuous variables were analyzed by multiple linear regression models. Results The study sample included 4559 infants with 1422 (31.2%) who underwent primary cleft rhinoplasty. Over time, there was a significant increase in the proportion of cleft lip repairs accompanied by a rhinoplasty ( p < .01). A greater proportion of patients with unilateral cleft lips received simultaneous rhinoplasty with their lip repairs (33.8 vs 26.0% , p < .01). This cohort had a significantly shorter length of stay (1.6 vs 2.8 days , p < .01) when compared to children that underwent cleft lip repair alone. Conclusions Performing primary cleft rhinoplasty is becoming more common among cleft surgeons. Considering comparable costs and complication rates, a rhinoplasty should be considered during the surgical treatment planning of patients with cleft nasal deformities.

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Nasoalveolar Molding for Unilateral and Bilateral Cleft Lip Repair

Oral and Maxillofacial Surgery Clinics of North America ◽

10.1016/j.coms.2020.01.008 ◽

2020 ◽

Vol 32 (2) ◽

pp. 197-204 ◽

Cited By ~ 1

Author(s):

Hitesh Kapadia ◽

Douglas Olson ◽

Raymond Tse ◽

Srinivas M. Susarla

Keyword(s):

Cleft Lip ◽

Bilateral Cleft Lip ◽

Cleft Lip Repair ◽

Nasoalveolar Molding

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Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211062042 ◽

2021 ◽

pp. 105566562110620

Author(s):

Katelyn Kondra ◽

Eloise Stanton ◽

Christian Jimenez ◽

Kalvyn Ngo ◽

Jordan Wlodarczyk ◽

...

Keyword(s):

Weight Gain ◽

Los Angeles ◽

Cleft Lip ◽

Retrospective Chart Review ◽

Multiple Time ◽

Feeding Difficulties ◽

Time Points ◽

Cleft Lip Repair ◽

Multiple Time Points ◽

Nasoalveolar Molding

Objective This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms. Design Retrospective review. Setting Children's Hospital of Los Angeles, California. Patient, Participants A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020. Interventions No intervention was performed. Main Outcome Measure(s) Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups. Results 107 patients met inclusion criteria: ECLR, n = 51 (47.6%); TLR + NAM, n = 35 (32.7%); and TLR-NAM, n = 21 (19.6%). ECLR patients had significantly greater changes in weight from surgery to 8-weeks and from surgery to 24-months postoperatively compared with both TLR ± NAM ( P < .05). Age-matched weights in the ECLR group were significantly greater than TLR ± NAM at multiple time points postoperatively ( P < .05). Conclusions ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.

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