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Abstract
Nasoalveolar molding (NAM) is commonly employed to reduce the alveolar segments into proper alignment and to improve nasal symmetry in patients with cleft lip and palate. This study examines the periodical progression of NAM treatment over time. 20 patients with complete unilateral cleft lip and palate were prospectively recruited. A 2 stage NAM treatment protocol was applied. Stage 1 involved adjustment of the alveolar segments (mean age 15.6 days), while Stage 2 added nasal stents and started average 43 days after stage 1. 3D images (n = 241) were obtained prior to NAM initiation and weekly until the end of treatment. The cleft lip area, bilateral nostril areas, and the nostril height and width were measured. Treatment was assessed in the Cleft (C) side and the Non-cleft (N). There was significant difference in the C/N ratio of the nostril area, width, and height at pre-treatment (0.9 ± 0.3, 4.1 ± 1.1, and 0.5 ± 0.2), at the end of stage 1 (1.1 ± 0.3, 2.2 ± 0.6, and 0.8 ± 0.2), and at the end of stage 2 treatment (1.8 ± 0.3, 1.8 ± 0.4, and 1.2 ± 0.1); p < 0.05. Comparative 3D analysis with dense sampling offers a precise methodology for showing effects of NAM treatment. The morphological changes achieved with NAM therapy occur in early treatment phase.
Highlights
Preoperative narrowing of the lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcome by minimizing wound healing disturbances and scarring[2]
Image analysis was performed on 20 patients with unilateral complete cleft lip and palate who underwent Nasoalveolar molding (NAM) treatment
It was intriguing to observe that the nostril width asymmetry between cleft and non-cleft sides continued to decrease in the second stage of NAM treatment
Summary
Preoperative narrowing of the lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcome by minimizing wound healing disturbances and scarring[2]. In 1999, Grayson proposed a pre-surgical nasoalveolar molding (NAM) procedure that consists of infant premaxillary orthopedics and nasal molding to reduce the severity of the cleft lip deformity and improve the symmetry of the nose prior to surgical repair[3,4,5]. Some clinicians believe NAM is an indispensable technique to reduce the severity of the initial defect, aligning alveolar segments, normalizing lower lateral nasal cartilage position, and expanding nasal lining[6, 7]. Despite noting a paucity of high-level evidence, a recent systematic review found that protocols involving NAM may improve nasal symmetry in the first 1 to 6 years[8]. We can find very few studies addressing the progressive temporal morphological changes in the lip and nose which occur with NAM treatment
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