The Effects of Nasoalveolar Molding on Nasal Proportions at the Time of Nasal Maturity

Background: The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity. Methods: A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners. Results: Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM. Conclusion: The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.

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Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate

Contemporary Clinical Dentistry ◽

10.4103/0976-237x.194104 ◽

2016 ◽

Vol 7 (4) ◽

pp. 569 ◽

Cited By ~ 6

Author(s):

PrabhakarRamasetty Attiguppe ◽

YM Karuna ◽

Chandrashekar Yavagal ◽

SaraswathiV Naik ◽

BM Deepak ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Nasoalveolar Molding

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A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000008462 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Nicole M. Kurnik ◽

Mert Calis ◽

Danielle L. Sobol ◽

Hitesh Kapadia ◽

Ezgi Mercan ◽

...

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Comparative Assessment ◽

Nasoalveolar Molding

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Photometric Evaluation in Adolescence of Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617732785 ◽

2017 ◽

Vol 55 (4) ◽

pp. 568-573 ◽

Cited By ~ 1

Author(s):

Maria Costanza Meazzini ◽

Carlo Chiavenna ◽

Luca Autelitano ◽

Giovanna Garattini ◽

Roberto Brusati

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Matched Control ◽

The Other ◽

Nasal Tip ◽

Other Hand ◽

Nasolabial Angle ◽

Bilateral Cleft Lip ◽

Nasoalveolar Molding ◽

Photographic Records

Objective: Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip. Design: The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM). Setting and Patients: 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents. Results: Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample. Conclusions: NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.

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Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620906293 ◽

2020 ◽

Vol 57 (6) ◽

pp. 700-706

Author(s):

Neha Bhutiani ◽

Tulika Tripathi ◽

Mahesh Verma ◽

Padam Singh Bhandari ◽

Priyank Rai

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Treatment Time ◽

Percentage Increase ◽

Morphological Parameters ◽

Arch Form ◽

Width Difference ◽

Nasoalveolar Molding

Objective: To analyze the effects of presurgical nasoalveolar molding (PNAM) in newborns with cleft lip and palate and evaluate its postsurgical stability at 1-year follow-up using a nasal stent. Design: Prospective clinical trial. Setting: Department of Orthodontics, Maulana Azad Institute of Dental Sciences, Delhi. Patients: Patients with cleft lip and palate of 0 to 6 months. Sample size 25 recruited, 16 satisfactorily completed the procedure. Interventions: Presurgical nasoalveolar molding done as indicated in all the patients. Postsurgical external nasal stents were given for 1 year to maintain the nasal correction. Main Outcome Measures: Changes in cleft defect and maxillary arch were recorded pre- and post-PNAM. Changes in nasal morphological parameters assessed pre- and post-PNAM and 1 year after surgical repair following the use of nasal stent. Results: There was a significant reduction in cleft defect assessed both intraorally ( 4.16 mm) and extra orally ( 4.42 mm) at the end of PNAM therapy (average treatment time 4 months). The nasal morphology improved with an increase in columella height (1.5 mm) and reduction in columella width. Bialar width reduced (2.90 mm) with an increase in nostril height ( 2.10 mm). Better symmetry was achieved in all cases as the nostril height and width difference changed significantly pre- and post-nasoalveolar molding. The percentage increase in columella height was greater for infants less than 6 weeks. Conclusions: Presurgical nasoalveolar molding considerably reduces the cleft gap and improves arch form making surgical union easier along with improved nasal morphology which can be maintained at 1-year postsurgery by use of a postsurgical external nasal stent.

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

Orthodontics and Craniofacial Research ◽

10.1111/j.1601-6343.2007.00390.x ◽

2007 ◽

Vol 10 (3) ◽

pp. 161-166 ◽

Cited By ~ 50

Author(s):

GD Singh ◽

D Levy-Bercowski ◽

MA Yáñez ◽

PE Santiago

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Three Dimensional ◽

Facial Morphology ◽

Nasoalveolar Molding

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Photometric Evaluation of Adult Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211024069 ◽

2021 ◽

pp. 105566562110240

Author(s):

Maria Costanza Meazzini ◽

Francesca Parravicini ◽

Vera Donati ◽

Roberto Brusati ◽

Federico Biglioli ◽

...

Keyword(s):

Young Adults ◽

Young Adulthood ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Adult Patients ◽

Nasal Tip ◽

Nasolabial Angle ◽

Primary Rhinoplasty ◽

Bilateral Cleft Lip ◽

Nasoalveolar Molding

A short columella and a flattened nasal tip are the characteristic stigmata of patients with complete bilateral cleft lip and palate (BCLP). Objective: The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM). Setting and Patients: A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults. Results: Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width. Conclusions: Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample.

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Three-Dimensional Printing in Cleft Care: A Systematic Review

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211013175 ◽

2021 ◽

pp. 105566562110131

Author(s):

Farrukh R. Virani ◽

Evan C. Chua ◽

Mary Roz Timbang ◽

Tsung-yen Hsieh ◽

Craig W. Senders

Keyword(s):

Systematic Review ◽

3D Printing ◽

Clinical Outcomes ◽

Outcome Measures ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Secondary Outcome ◽

Exclusion Criteria ◽

3 Dimensional ◽

Dimensional Printing

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. Design: Retrospective systematic review. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

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