Post-cheilorhinoplasty esthetic evaluation of unilateral cleft lip and palate infants treated with and without pre-surgical nasoalveolar molding

Abstract

Objectives: Unilateral cleft lip and palate sets many challenges both functional and esthetic. Cleft patients are at an elevated risk for developing psychosocial problems. The objective of this study was to assess any difference in esthetics post-cheilorhinoplasty in unilateral cleft lip and palate (UCLP) infants treated with and without nasoalveolar molding. Materials and Methods: Esthetic evaluation of nasolabial appearance and comparative analysis of photographic records collected post-cheilorhinoplasty for presurgical nasoalveolar molding (PNAM), lip-tape (LPTP), no pre-treatment (NoPreTx), and control (CTRL) groups were done using 5 point scale. There were six evaluators, two orthodontists, and one maxillofacial surgeon each from the two participating institutions. Paired “t”-test for nasolabial score comparison between groups, Cronbach’s alpha for reliability analysis, and Fleiss Kappa for interevaluator agreement were used for statistics. All statistical analysis was done at confidence level of 95% and 0.05 as level of significance. Results: Significant difference was found between nasolabial esthetic scores for PNAM group when compared to LPTP (P = 0.000) and NoPreTx (P = 0.001) groups. Infants who underwent PNAM had better nasolabial esthetic scores in all categories compared to infants who underwent LPTP or NoPreTx. The scale of measurement and the nasolabial esthetic evaluation scores were coherent and reliable as shown by Crohnbach’s alpha (<0.9) both for individual components and for overall score. Conclusion: UCLP infants who were brought by their parents to the craniofacial center early within 1 month of their birth and who underwent nasoalveolar molding therapy before cheilorhinoplasty had significantly better nasolabial esthetics post-surgery.