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.
Highlights
Various pre- and postsurgical orthodontic and orthofacial techniques have been introduced over the past few decades, in order to overcome the problems associated with wide unilateral cleft lip (UCL), unilateral cleft lip palate (UCLP) or bilateral cleft lip palate (BCLP)
Between March 2010 and November 2012 we offered nasoalveolar molding (NAM) according to the Grayson technique to the parents of 40 neonates with UCL, UCLP (Fig. 1) or BCLP (Fig. 2) deformities as an optional presurgical orthofacial treatment
Comparing pre- and posttreatment results of UCLP and UCL (Table 4), for all parameters the extent of change was found to be higher in the UCLP group, but significance was only found for the reduction of nostril width
Summary
Various pre- and postsurgical orthodontic and orthofacial techniques have been introduced over the past few decades, in order to overcome the problems associated with wide unilateral cleft lip (UCL), unilateral cleft lip palate (UCLP) or bilateral cleft lip palate (BCLP). Among others, these techniques include oral pinning and traction, pinned co-axial screw, advancement of the cleft maxillary segment, nasal stenting, nasoalveolar molding (NAM) and modifications of NAM [1,2,3,4]. NAM was introduced into cleft care and first described by Grayson in the early 1990s [4]. PLOS ONE | DOI:10.1371/journal.pone.0118103 March 3, 2015
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