Abstract
Background: Midface symmetry is an important indicator of success of complete unilateral cleft lip and palate (CUCLP) treatment. There is little literature on the long-term effects of Presurgical Nasoalveolar Molding (PNAM) on Midface symmetry in children treated for CUCLP.
 Material and Methods: This case-control study was carried out in the Department of Burn and Plastic Surgery at Government Medical College and Hospital, Bettiah, Bihar, India from may 2018 to Dec 2019. Complete unilateral CL+P patients had basilar and frontal photographs at two time points: (1) initial (2) postsurgical. 30 nasal molding patients and 20 control patients were included. Presurgical nasal molding was performed prior to primary lip repair in intervention group. No nasal molding was performed in control group.
 Results: A statistically significant difference was found for postsurgical nostril height-width ratio (P< .05). No other statistically significant differences were found.
 Conclusion: Nasal molding and surgery resulted in more symmetrical nostril height-width ratios than surgery alone. Alar groove ratios were not statistically significantly different between groups perhaps because application of nasal molding was not early enough; postsurgical nasal splints were not utilized; overcorrection was not performed for nasal molding
Highlights
Use of presurgical nasoalveolar molding (NAM) and similar orthopedics in the management of cleft deformities has been a subject of occasional controversy.[1,2] Appliance effectiveness, cost, and treatment time have been previous subjects of debate
Nasal molding and surgery resulted in more symmetrical nostril height-width ratios than surgery alone
Nasal molding subjects had superior postsurgical nostril symmetry compared to controls in relation to nostril height: width ratios
Summary
Use of presurgical nasoalveolar molding (NAM) and similar orthopedics in the management of cleft deformities has been a subject of occasional controversy.[1,2] Appliance effectiveness, cost, and treatment time have been previous subjects of debate. Mastuo and Hirose[3] recognized the moldability of nasal cartilages in the early months of an infant’s life and attributed this to high levels of estrogen and increased hyaluronic acid. They are appearance of the appliance design.[5] The University of Illinois uses the NAM appliance solely for nasal molding. There is little literature on the long-term effects of Presurgical Nasoalveolar Molding (PNAM) on Midface symmetry in children treated for CUCLP
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