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Thiruvenkatachari B, Bonanthaya K, Kuijpers Jagtman AM, Sandler J, Powar RS, Hussain SA, Subramaniyan B, Bhola N, Bhat HK, Ramachandra V, Jayakumar S, Batra P, Chakkaravarthi S, Thailavathy V, Prathap M, Elumalai T, Nambiar K, Vijayakumar C, Mahajan RK, Sood SC, Kahlon SS, Bijapur S, Kamble RH, Keluskar KM, Nilgar A, Khan FA, Das D, Sridhar S, Buch A, Kumar S, Mohanraj R, Listl S, Chopra S, Jadhav V, Arora A, Valiya C, Pattamata M. A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial. Trials 2024; 25:453. [PMID: 38965585 PMCID: PMC11223389 DOI: 10.1186/s13063-024-08229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).
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Affiliation(s)
- Badri Thiruvenkatachari
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.
| | | | - Anne Marie Kuijpers Jagtman
- Department of Orthodontics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland
| | - Jonathan Sandler
- Chesterfield Royal Hospital, Chesterfield Royal Hospital NHS Foundation Trust, Calow, England
| | - Rajesh S Powar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Syed Altaf Hussain
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - B Subramaniyan
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - Nitin Bhola
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Hari Kishore Bhat
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | | | - Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | - Subhiksha Chakkaravarthi
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - V Thailavathy
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Manoj Prathap
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Thulasiram Elumalai
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Karthika Nambiar
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Charanya Vijayakumar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | | | | | - K M Keluskar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Amit Nilgar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Faizan Ahmed Khan
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | - Swetha Sridhar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | - Stefan Listl
- Heidelberg University BIOMS: Universitat Heidelberg Bioquant, Heidelberg, Germany
| | | | - Vikrant Jadhav
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Anika Arora
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - Madhuri Pattamata
- Radboud Universiteit Nijmegen: Radboud Universiteit, Nijmegen, The Netherlands
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Nirunrungrueng P, Virarat P, Techalertpaisarn P, Ungvijanpunya N. Nasolabial morphological changes in patients with unilateral cleft lip and palate using a Korat-modified nasoalveolar moulding appliance with primary correction. Orthod Craniofac Res 2024; 27 Suppl 1:80-89. [PMID: 38305564 DOI: 10.1111/ocr.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The objective of this study is to measure the morphological changes of the nose and lip in patients with unilateral cleft lip and palate before and after cheiloplasty with primary rhinoplasty (primary correction) in conjunction with Korat-NAM usage. DESIGN Longitudinal cohort study. SETTING Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. SUBJECTS Twenty-six patients with unilateral cleft lip and palate. INTERVENTIONS Control group: only active obturator before primary correction. Experimental group: an active obturator and Korat-NAM I before primary correction. A customized endotracheal tube was retained in the nostril for 3 weeks before switching to Korat-NAM II for 1 year. MAIN OUTCOME MEASURES Six measurements comprising nostril rim length, nostril height, nostril sill width, columella angle, vertical lip height, and horizontal lip length were measured from the patients' photographs. All measurements, except the columella angle, were reported as the cleft side/non-cleft side value ratio. Measurements were taken at the initial appointment, immediately before, 3 weeks after, and 1 year after primary correction. RESULTS Nostril rim length ratio, nostril height ratio, nostril sill width ratio, columella angle on the cleft side, and vertical lip height ratio were improved using Korat-NAM before and 3 weeks after primary correction. Nostril rim length and height ratios were significantly better than the control group. CONCLUSIONS Korat-NAM improved nose and lip morphology before primary correction. An overcorrection improved the nose and lip morphology on the cleft side. The nostril rim length and vertical lip height on the cleft side also improved with Korat-NAM II 1 year after primary correction.
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Affiliation(s)
| | - Pongjai Virarat
- Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | - Nicha Ungvijanpunya
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, Santiago PE. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J 2024; 61:654-677. [PMID: 36330703 DOI: 10.1177/10556656221136325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. MAIN OUTCOME MEASURES Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. RESULTS A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. CONCLUSIONS Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
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Affiliation(s)
| | | | - Rose Trotta
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Andrew Hollins
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Ronnie Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Alexander C Allori
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Pedro E Santiago
- Duke University School of Medicine, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
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Fangueiro DG, Garib DG, Conti ACDCF, Largura L. Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization. Dental Press J Orthod 2024; 29:e2423115. [PMID: 38567921 PMCID: PMC10983844 DOI: 10.1590/2177-6709.29.1.e2423115.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. METHODS The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). RESULTS People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. CONCLUSIONS The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.
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Affiliation(s)
- Daniel Giaretta Fangueiro
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais (Bauru/SP, Brazil)
- Universidade do Sagrado Coração, Faculdade de Odontologia (Bauru/SP, Brazil)
| | - Daniela Gamba Garib
- Universidade de São Paulo, Faculdade de Odontologia de Bauru (Bauru/SP, Brazil)
| | - Ana Cláudia de Castro Ferreira Conti
- Universidade do Sagrado Coração, Faculdade de Odontologia (Bauru/SP, Brazil)
- Universidade Norte do Paraná, Faculdade de Odontologia (Londrina/PR, Brazil)
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Alfonso AR, Park JJ, Kalra A, DeMitchell-Rodriguez EM, Kussie HC, Shen C, Staffenberg DA, Flores RL, Shetye PR. The Burden of Care of Nasoalveolar Molding: An Institutional Experience. J Craniofac Surg 2024:00001665-990000000-01282. [PMID: 38231199 DOI: 10.1097/scs.0000000000009960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024] Open
Abstract
Nasoalveolar molding (NAM) is an early presurgical intervention to facilitate primary cleft lip repair by reducing cleft severity and improving labial and nasal form. However, it continues to be associated with the burden of care that influences access and completion of therapy. The authors, therefore, aim to determine the burden of care of NAM therapy for families seeking treatment at a high-volume urban cleft center. A retrospective study of all patients undergoing primary cleft repair between 2012 and 2020 was performed. Patients were grouped based on whether or not NAM therapy was offered. Variables including physical, psychosocial, and financial factors were assessed. Two hundred and thirty patients underwent primary cleft repair between 2012 and 2020. Of these, 176 patients were indicated for NAM, with 4% discontinuing, and 54 patients did not undergo NAM. The 169 patients who completed NAM had a mean duration of treatment of 13.6±8.8 wks consisting of 15±6 scheduled NAM adjustment visits and 1±1 unscheduled visit made urgently to assess caregiver concerns. The mean travel distance was 28.6±37.1 miles. Eighty-four percent of caregivers were married, and 16% did not have English as a primary language. Though 57% had private insurance, 43% of patients received charity support for their treatment. NAM is a finite presurgical intervention that requires caregivers to participate in patient care for approximately three months of their early life. The decision to pursue NAM should be considered alongside the burden of care for caregivers to complete treatment.
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Affiliation(s)
- Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Ocak I, Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate. Int J Paediatr Dent 2024; 34:94-101. [PMID: 37351851 DOI: 10.1111/ipd.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nasoalveolar molding (NAM) is a presurgical orthopedic technique used in the management of cleft lip and palate deformities. Despite the widespread use of NAM therapy, there is a need for further investigation to assess its specific effects on arch dimensions and malocclusion characteristics. AIM To evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion characteristics in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). DESIGN Patients in primary dentition were referred to the Institutional Department of Orthodontics. The NAM group consisted of 21 patients with UCLP (mean age 4.7 ± 0.7 years) and 12 patients with BCLP (mean age 4.8 ± 0.7 years). Sixteen patients with UCLP (mean age 4.9 ± 0.9 years) and five patients with BCLP (mean age 5.4 ± 1.1 years) were included in the non-NAM group. The plaster models of all patients were digitized. Dental arch dimensions and malocclusion characteristics were analyzed via digital software. One-way ANOVA with Bonferroni correction was used for statistical analysis. RESULTS Intercanine and intermolar widths showed statistically significant differences according to the cleft type (p < .01). There was no statistically significant effect of NAM therapy on maxillary arch parameters and malocclusion characteristics (p > .05). The prevalence of anterior crossbite was 12.1% in the NAM group and 23.8% in the non-NAM group. CONCLUSION NAM therapy did not affect the maxillary arch dimensions and malocclusion characteristics in patients with UCLP and BCLP. The cleft type was the main factor, leading to a significant difference in maxillary widths.
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Affiliation(s)
- Irmak Ocak
- Department of Orthodontics, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic Reconstructive and Aesthetic Surgery, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Shaik N, Eggula A, Pudi S, Yemineni BC, Jagati S, Cheduravally TR. Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report. Int J Clin Pediatr Dent 2023; 16:659-662. [PMID: 37731793 PMCID: PMC10507294 DOI: 10.5005/jp-journals-10005-2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Aim and objective The present clinical report describes management of complete unilateral cleft lip and palate with presurgical nasoalveolar molding (NAM) therapy for infants. Background Orofacial clefts have a negative impact on the health and social integration of individuals affected. Patients undergo numerous procedures until they reach adolescence. The ultimate focus of surgical intervention is to improve the esthetic appearance of the lip and nose by improving the lip scar, nasal tip projection, and symmetry of the nasolabial complex. Case description This paper discusses a situation in which the parents of a three days old baby with the chief complaint of regurgitation of milk while feeding. On examination, baby had complete left-sided cleft lip and cleft palate (CL+CP). Conclusion Before surgery, nasoalveolar molding has been shown to be a useful adjunctive therapy for reducing hard and soft tissue cleft deformity. Clinical significance Passive preoperative intervention of the lip and alveolar segments helps to reduce tissue tension and is thought to improve surgical outcomes by minimizing wound healing disturbances and scarring. How to cite this article Shaik N, Eggula A, Pudi S, et al. Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report. Int J Clin Pediatr Dent 2023;16(4):659-662.
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Affiliation(s)
- Naseemoon Shaik
- Department of Pedodontics & Preventive Dentistry, MNR Dental College & Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Anusha Eggula
- Department of Pedodontics & Preventive Dentistry, MNR Dental College & Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Sriharsha Pudi
- Department of Prosthodontics Crown and Bridge, MNR Dental College & Hospital, Sangareddy, Hyderabad, Telangana, India
| | - Bhavan C Yemineni
- Department of Maxillofacial Prosthodontics and Implantology, ASRAM Medical College, Hospital & Research Centre, Eluru, Andhra Pradesh, India
| | - Sravanthi Jagati
- Department of Pedodontics & Preventive Dentistry, MNR Dental College & Hospital, Sangareddy, Hyderabad, Telangana, India
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Thakur S, Jishad C, Thakur NS, Deep A. Changes in nasal symmetry after presurgical nasoalveolar molding in infants treated with complete unilateral cleft lip and palate: A follow-up study. Dent Res J (Isfahan) 2022; 19:95. [PMID: 36605133 PMCID: PMC9807967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/22/2022] [Accepted: 06/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background A significant improvement in the nasal symmetry after presurgical nasoalveolar molding (PNAM) is seen in complete unilateral cleft lip and palate (UCLP) infants. However, the follow-up changes in the nasal symmetry before and after PNAM and surgical repair have not been well documented. Materials and Methods The purpose of this retrospective study is to assess the progressive changes in the nasal symmetry after PNAM and primary cheiloplasty to 1 year in complete UCLP infants. Out of 28 complete UCLP patients who were given PNAM treatment during the period between January 2014 to March 2019, 19 UCLP infants could be included for the study. Submental oblique photographs at the initial visit (T1), immediately after cheiloplasty (T2), and 1 year (T3) after cheiloplasty were selected, and quantity of nasal asymmetry at each period (T1-T2; T1-T3; and T2-T3) was analyzed by paired t-test (P < 0.05). Results The quantity of asymmetry revealed that there was a highly significant improvement (P < 0.001) in nasal asymmetry at T1-T2 and T1-T3. Nonsignificant relapse was observed at T2-T3; however, a significant relapse in nasal dome height was observed during this period. Conclusion The improvement in the nasal symmetry after cheiloplasty in PNAM-treated patients is maintained till 1 year postsurgically though there is a nonsignificant relapse.
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Affiliation(s)
- Seema Thakur
- Department of Pediatric and Preventive Dentistry, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India,Address for correspondence: Dr. Seema Thakur, Department, Pediatric and Preventive Dentistry, H.P. Government Dental College & Hospital, Shimla, Himachal Pradesh, India. E-mail:
| | - C. Jishad
- Department of Pediatric and Preventive Dentistry, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Narbir Singh Thakur
- Department of Oral and Maxillofacial Pathology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Aman Deep
- Department of Pediatric and Preventive Dentistry, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Lips and noses in 10-year old patients with repaired complete unilateral clefts of lip, alveolus, and palate. A prospective three-centre study of the Baltic Cleft Network. J Craniomaxillofac Surg 2021; 50:246-253. [PMID: 34961665 DOI: 10.1016/j.jcms.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/06/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.
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Wang XW, Liu ZJ, Diao J, Zhao YJ, Jiang JH. Morphologic reproducibility in 6 regions of the 3-dimensional facial models acquired by a standardized procedure: An in vivo study. Am J Orthod Dentofacial Orthop 2021; 161:e287-e295. [PMID: 34924284 DOI: 10.1016/j.ajodo.2020.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION A standardized procedure was proposed to control involuntary motion and other factors during the capture of structural light scanning that could influence the morphology of 3-dimensional facial models; interoperator reproducibility was evaluated. METHODS Twenty subjects volunteered for facial scanning. Three researchers scanned each volunteer 3 times on the same day using the FaceScan structural light scanning system (Isravision, Darmstadt, Germany) and after the proposed procedure. Captures were done at 5-minute intervals. The 3 facial scans acquired by the same researcher were compared by reverse engineering software (Geomagic; 3D Systems, Rock Hill, SC). Six facial regions, including forehead, nose, paranasal, upper lip, lower lip and chin, and cheek, were divided. With the first scan as a reference, the other 2 scans were registered, and surface-to-surface distance maps were acquired to calculate the mean, standard deviation, and root mean squares (RMS) between 2 surfaces. The reproducibility between 3 researchers was then evaluated by a 1-way analysis of variance. RESULTS The mean of 6 facial regions was close to 0. The RMS of lip regions were largest (0.48-0.53 mm), the forehead was smallest (0.21 mm), and the others ranged 0.37 mm to 0.42 mm. The standard deviation was slightly smaller than RMS and had the same trend of change. There was no significant difference in RMS among the 3 researchers (P >0.05). CONCLUSIONS With the constraint of the standardized procedure, the morphologic reproducibility of facial models in 6 regions was satisfying.
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Affiliation(s)
- Xin-Wen Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zi-Jin Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jing Diao
- Department of Preventive Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi-Jiao Zhao
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Jiu-Hui Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
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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. Plast Reconstr Surg 2021; 148:1075-1084. [PMID: 34546190 DOI: 10.1097/prs.0000000000008462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although many cleft teams have adopted nasoalveolar molding to improve nasal form, few comparative studies have assessed the postoperative benefits of this treatment. Given that reported outcomes have been contradictory and that treatment involves considerable burden to families, the purpose of this study was to assess objective and subjective changes from nasoalveolar molding at approximately 5 years of age. METHODS All patients with complete unilateral cleft lip and palate who underwent primary cheiloplasty performed by a single surgeon over a 7-year period were reviewed. Patient results were grouped into nasoalveolar molding or no-nasoalveolar molding. Cleft severity and aesthetic outcomes were assessed by panels of raters who independently ranked subject images at presentation, immediately preoperative (after molding), and at 5-year follow-up. Objective symmetry was measured using standard anthropometric analysis on three-dimensional images. RESULTS Among 41 patients included, 16 successfully completed nasoalveolar molding. Both groups were similar at presentation; however, the nasoalveolar molding group had improved appearance following molding (p < 0.05). After surgery, at 5 years of age, the nasoalveolar molding group had better rank scores for overall appearance (p < 0.05), cleft nostril height, and cleft medial lip height (p < 0.05). Regression analysis revealed that nasoalveolar molding treatment was the most significant predictor of overall nasal appearance at 5 years, but that treatment team experience and initial severity were also significant predictors (p < 0.05). Qualitative audit following analysis identified favorable and unfavorable features of nasoalveolar molding. CONCLUSION In children with complete unilateral cleft lip and palate, nasoalveolar molding was associated with better overall nasal aesthetics and improved cleft nostril height and cleft medial lip height at approximately 5 years of age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate. Plast Reconstr Surg 2021; 148:775e-784e. [PMID: 34705782 DOI: 10.1097/prs.0000000000008463] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Aihara Y, Yanagawa T, Sasaki M, Sasaki K, Shibuya Y, Adachi K, Togashi S, Takaoka S, Tabuchi K, Bukawa H, Sekido M. Nasal molding prevents relapse of nasal deformity after primary rhinoplasty in patients with unilateral complete cleft lip: An outcomes-based comparative study of palatal plate alone versus nasoalveolar molding. Clin Exp Dent Res 2021; 8:197-208. [PMID: 34689427 PMCID: PMC8874052 DOI: 10.1002/cre2.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives In recent years, many studies have reported that the presurgical nasoalveolar molding method improves the nose morphology; however, the reason for its effectiveness after surgery has never been understood. We evaluated the effect of nasoalveolar molding by comparing it with a passive orthopedic method without a nasal stent and focusing on the nostril morphology after primary cheiloplasty using various measurement methods. We then analyzed the essential factors. Materials and methods The patients involved were 31 infants with unilateral complete cleft lip and palate treated with primary cheiloplasty at the University of Tsukuba Hospital from 2004 to 2011. Of the 31 infants, 16 received nasoalveolar molding treatment and 15 received passive orthopedic treatment as controls. Photographic facial measurements were performed for all patients immediately and 7 months after primary cheiloplasty. The esthetics of the nostrils were assessed according to the left–right nostril symmetry, as measured by the Hausdorff distance, area ratio, perimeter ratio, and aspect a/u (the aspect ratio of the affected side)/(the aspect ratio of the unaffected side) ratio. In addition, the inclination of the nasal ridge was assessed using anthropometric measurements (Grc‐Grn∠midline and midline∠columellar axis). Results The area ratio, perimeter ratio, and Grc‐Grn∠midline were significantly greater in the nasoalveolar molding group immediately after surgery (p = 0.00062, 0.016, and 0.048, respectively) than in the control group. However, the Hausdorff distance and aspect a/u ratio were more favorable (p = 0.0018 and 0.0039, respectively) in the nasoalveolar molding group after 7 months. Conclusions The results of our study suggested that using nasoalveolar molding as a presurgical orthopedic treatment could improve the shape of the nasal cartilage with surgeon's corrections.
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Affiliation(s)
- Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoichiro Shibuya
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koji Adachi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Togashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuhiko Tabuchi
- Department of Molecular and Cellular Physiology, Institute of Medicine, Academic Assembly, Shinshu University, Nagano, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Presurgical Orthopedic Intervention Prior to Cleft Lip and Palate Repair: Nasoalveolar Molding Versus Passive Molding Appliance Therapy. J Craniofac Surg 2021; 32:486-491. [PMID: 33704966 DOI: 10.1097/scs.0000000000006929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nasoalveolar molding (NAM) is a widely used presurgical orthopedic device, despite disputes over its effectiveness. This study compares the outcomes after cleft lip and nose repair in patients who received NAM versus those who underwent passive alveolar molding with lip taping. METHODS A retrospective review of patients with complete unilateral cleft lip and palate who received either NAM (n = 16) or passive molding (n = 10) treatments was conducted. Alveolar gap width was measured on maxillary casts until time of palatoplasty. Nasolabial symmetry was assessed by examining anthropometric ratios on post-operative three-dimensional photographs. Burden of care was evaluated by analyzing the number of patient appointments attended, treatment costs, and caregiver satisfaction surveys. RESULTS No statistically significant difference existed in alveolar gap at time of initial appointment or palatoplasty, however the gap was smaller in the NAM cohort at time of lip and nose repair. No statistically significant difference existed in postsurgical heminasal width, nostril width, nostril height, labial height or nasal ala projection asymmetry between the NAM and the passive molding cohort. Patients in the NAM group attended more dental appointments and incurred higher treatment costs compared to the passive molding group. Caregivers reported high satisfaction with treatment outcomes in both cohorts. CONCLUSIONS There were no differences between NAM and passive molding regarding postsurgical nasolabial appearance and patient satisfaction. Both treatments narrow the alveolar gap. However, NAM places a higher burden of care on families.
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The Nasoalveolar Molding Cleft Protocol: Long-Term Treatment Outcomes from Birth to Facial Maturity. Plast Reconstr Surg 2021; 147:787e-794e. [PMID: 33890899 DOI: 10.1097/prs.0000000000007828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors present outcomes analysis of the nasoalveolar molding treatment protocol in patients with a cleft followed from birth to facial maturity. METHODS A single-institution retrospective review was conducted of cleft patients who underwent nasoalveolar molding between 1990 and 2000. Collected data included surgical and orthodontic outcomes and incidence of gingivoperiosteoplasty, alveolar bone grafting, surgery for velopharyngeal insufficiency, palatal fistula repair, orthognathic surgery, nose and/or lip revision, and facial growth. RESULTS One hundred seven patients met inclusion criteria (69 with unilateral and 38 with bilateral cleft lip and palate). Eighty-five percent (91 of 107) underwent gingivoperiosteoplasty (unilateral: 78 percent, 54 of 69; bilateral: 97 percent, 37 of 38). Of those patients, 57 percent (52 of 91) did not require alveolar bone grafting (unilateral: 59 percent, 32 of 54; bilateral: 54 percent, 20 of 37). Twelve percent (13 of 107) of all study patients underwent revision surgery to the lip and/or nose before facial maturity (unilateral: 9 percent, six of 69; bilateral: 18 percent, seven of 38). Nineteen percent (20 of 107) did not require a revision surgery, alveolar bone grafting, or orthognathic surgery (unilateral: 20 percent, 14 of 69; bilateral: 16 percent, six of 38). Cephalometric analysis was performed on all patients with unilateral cleft lip and palate. No significant statistical difference was found in maxillary position or facial proportion. Average age at last follow-up was 20 years (range, 15 years 4 months to 26 years 10 months). CONCLUSIONS Nasoalveolar molding demonstrates a low rate of soft-tissue revision and alveolar bone grafting, and a low number of total operations per patient from birth to facial maturity. Facial growth analysis at facial maturity in patients who underwent gingivoperiosteoplasty and nasoalveolar molding suggests that this proposal may not hinder midface growth. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Padovano WM, Skolnick GB, Naidoo SD, Snyder-Warwick AK, Patel KB. Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2021; 59:462-474. [PMID: 33882703 DOI: 10.1177/10556656211009702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to investigate long-term treatment effects of nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate (UCLP). DESIGN Included manuscripts met the following criteria: (1) involved patients with UCLP who received NAM; (2) included comparison group(s) who either received non-NAM passive presurgical infant orthopedic appliances (PSIO) or who did not receive any PSIO; (3) reported at least one objective or validated measure of nasolabial, craniofacial, or palatal form; and (4) had patient follow-up beyond 4 years of age. RESULTS A total of 12 studies were included in this review. Meta-analyses were possible for Asher-McDade parameters and cephalometric measurements. Compared to patients who did not receive any PSIO, those who underwent NAM therapy were more likely to have good to excellent frontal nasal form (Risk ratio: 2.4, 95% CI: 1.24-3.68) and vermillion border (Risk ratio: 1.8, 95% CI: 1.19-2.71). However, there were no statistically significant differences in cephalometric measurements between these groups. Additionally, there were no statistically significant differences between patients receiving NAM versus non-NAM PSIO. There was insufficient evidence to determine the impact of NAM on dental arch development. CONCLUSIONS The preponderance of evidence in this review suggests that NAM produces benefits in nasolabial aesthetic form when compared with no appliance-based presurgical treatment. However, there is insufficient evidence to conclude whether NAM produces such benefits when compared with other passive PSIOs.
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Affiliation(s)
- William M Padovano
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
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Garland K, McNeely B, Dubois L, Matic D. Systematic Review of the Long-Term Effects of Presurgical Orthopedic Devices on Patient Outcomes. Cleft Palate Craniofac J 2021; 59:156-165. [PMID: 33678051 PMCID: PMC8750140 DOI: 10.1177/1055665621998176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To perform a systematic review of the literature to identify the long-term
effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed
to identify all English-language publications related to unilateral cleft
lip and palate, presurgical devices, and patient outcomes. Studies were
excluded if they did not report patient outcomes beyond 2 years of age, did
not describe the use of a PSO device, were case reports (n < 10), or were
purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were
selected for inclusion. Overall, there was no reported consensus as to the
long-term effects of PSO devices. Furthermore, this study identified that
only 10% of published research controlled for confounding factors that could
influence the reported results. Confounding factors that were identified
included different operating surgeon, different surgical protocols, and
different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly,
there is no consensus in the literature about the long-term effects of PSO
devices on long-term patient outcomes. Secondly, research in this domain is
limited by confounding factors that influence the applicability of the
reported results.
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Affiliation(s)
- Katie Garland
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Brendan McNeely
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Damir Matic
- Division of Plastic Surgery, Department of Surgery, Western University, London, Ontario, Canada
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Rossell-Perry P. The Surgical Nasoalveolar Molding: A Rational Treatment for Unilateral Cleft Lip Nose Deformity and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3044. [PMID: 32983795 PMCID: PMC7489733 DOI: 10.1097/gox.0000000000003044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
The purposes of this study were to evaluate surgical outcomes after primary surgery to address unilateral cleft lip, nose, and palate deformities and to perform a review of the literature to evaluate the effects of nasoalveolar molding (NAM) plus primary surgical repair on nonsyndromic unilateral cleft lip and palate. METHODS A cohort study of 37 primary complete unilateral cleft lip nasal deformity repairs was performed by a single surgeon. The outcomes were anthropometric measurements of the repaired lip, nose, and alveolar cleft width at the age of 1 and 5 years. A review of the literature was performed for studies published until March 2020 to evaluate the effect of presurgical NAM on nasolabial aesthetics. RESULTS Statistically significant differences were observed between pre- and postoperative columellar angle and alveolar cleft width. A total of 308 studies were identified, and 8 were included in the final analysis of 684 patients. The overall study quality was low according to the Oxford Centre of Evidence-Based Medicine, and GRADE level of evidence was low. CONCLUSIONS Primary cheilorhinoplasty alone is a good approach to improve nose appearance and alveolar gap in patients with unilateral cleft lip nose and palate deformity. Definitive conclusions about the effectiveness of presurgical NAM cannot be drawn. Available scientific evidence is not sufficient to demonstrate that combined use of presurgical nasoalveolar molding and primary surgery provides better nasolabial aesthetic outcomes than does primary surgery alone.
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Affiliation(s)
- Percy Rossell-Perry
- From the Post Graduate Studies School of Medicine, San Martin de Porres University, Santa Anita, Peru; and Department of Plastic Surgery, Edgardo Rebagliati Hospital, Lima, Peru
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Abstract
Orthodontic treatment of patients with unilateral and bilateral cleft palate requires an extensive interdisciplinary approach to achieve optimal functional and esthetic rehabilitation. Intervention is divided into 3 main stages: early mixed, late mixed, and permanent dentition. Treatment modalities can vary according to developmental stage, severity of cleft, and presence of other dentofacial abnormalities. This article describes the use and efficacy of different orthodontic, orthopedic, and surgical approaches at each developmental stage of unilateral and bilateral clefts, whereby the orthodontist plays a pivotal role in the different phases of growth and development of the cleft lip and the patient.
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Lautner N, Raith S, Ooms M, Peters F, Hölzle F, Modabber A. Three-dimensional evaluation of the effect of nasoalveolar molding on the volume of the alveolar gap in unilateral clefts. J Craniomaxillofac Surg 2019; 48:141-147. [PMID: 31917062 DOI: 10.1016/j.jcms.2019.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/13/2019] [Accepted: 12/15/2019] [Indexed: 12/01/2022] Open
Abstract
Over the last few decades it has been shown that nasoalveolar molding (NAM) has had an effect on the correction of nasal cartilage deformities and the alveolar process. This three-dimensional (3D) analysis evaluated the effects of NAM on the alveolar cleft region in patients with unilateral cleft lip and palate. Alveolar gap volumes were measured in a retrospective review of 40 dental casts of 20 patients with unilateral clef lip and palate before and after treatment. Ten patients who began undergoing NAM immediately after birth were included in this study. An additional 10 patients with unilateral clefts but without NAM were included as a control group. All of the casts (pretreatment and post-treatment) were 3D scanned, and the cleft volumes and anterior gap widths underwent computer-aided evaluations. NAM resulted in a significant reduction (p < 0.05) in alveolar gap volume and anterior cleft width from birth until lip closure time, while half of the control group showed slight increases in cleft volume. Based on these results, NAM is an effective and helpful treatment that can be used to significantly reduce alveolar gap volume and anterior cleft width in patients with unilateral clefts. Harmonization of the dental arch and a reduction in the alveolar cleft region are desirable treatment goals.
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Affiliation(s)
- Nora Lautner
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Stefan Raith
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Mark Ooms
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Florian Peters
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ali Modabber
- Department of Oral, Maxillofacial and Facial Plastic Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Jodeh DS, Ruso S, Feldman R, Ruas E, Rottgers SA. Clinical Outcomes Utilizing a "Modified Latham" Appliance for Presurgical Infant Orthopedics in Patients With Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:929-935. [PMID: 30526003 DOI: 10.1177/1055665618816892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Presurgical infant orthopedic manipulation is utilized prior to cleft lip/nasal repair to facilitate a gingivoperiosteoplasty (GPP) and primary nasolabial repairs. The Latham dentomaxillary advancement appliance uses a screw that must be tightened daily to approximate the cleft segments in unilateral complete clefts. Our cleft center has been utilizing a "modified Latham" appliance since 1987, including an orthodontic elastic power chain to close the gap in a shorter amount of time. We performed a retrospective chart review of all patients undergoing treatment at Johns Hopkins All Children's Hospital (JHACH) with a unilateral complete cleft lip and palate between 1987 and 2017. Patients were identified by the International Classification of Diseases, Ninth Revision code (749.21). The majority of the patients represent the experience of the senior authors (E.R. and R.F.). Two hundred and eighty-one patients with unilateral complete cleft lip/palate were identified. Seventy-five patients were treated with a "modified Latham" appliance prior to their lip repair. The "modified Latham" appliance remained in place on average 20.6 days (range: 4-82), and average hospital stay after placement was 1.18 days. Nearly 96% of patients underwent a successful GPP at the time of nasolabial repair. Modification of the Latham appliance by utilizing an elastic power chain and eliminating the screw allows rapid closure of the alveolar cleft with limited need for adjustments and outpatient visits. Direct approximation of the palatal segments allows successful completion of a GPP in 95.9% of patients with limited dissection.
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Affiliation(s)
- Diana S Jodeh
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Stephen Ruso
- 2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Randy Feldman
- 2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Ernesto Ruas
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.,2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - S Alex Rottgers
- 1 Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.,2 Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
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Akarsu-Guven B, Arisan A, Ozgur F, Aksu M. Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age. Am J Orthod Dentofacial Orthop 2018; 153:489-495. [PMID: 29602340 DOI: 10.1016/j.ajodo.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. MATERIALS Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. RESULTS No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. CONCLUSIONS NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood.
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Affiliation(s)
- Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Arda Arisan
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Figen Ozgur
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Hacettepe University, Ankara, Turkey.
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Massie JP, Bruckman K, Rifkin WJ, Runyan CM, Shetye PR, Grayson B, Flores RL. The Effect of Nasoalveolar Molding on Nasal Airway Anatomy: A 9-Year Follow-up of Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 55:596-601. [PMID: 29356619 DOI: 10.1177/1055665617744062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the effects of nasoalveolar molding (NAM) on nasal airway architecture. DESIGN Retrospective case-control study of patients with unilateral cleft lip treated with NAM vs without NAM. SETTING Tertiary referral center specializing in cleft and craniofacial care. Patients, Participants, and Interventions: Thirty-six patients with complete unilateral cleft lip and alveolus: 19 with NAM therapy and 17 without NAM therapy. MAIN OUTCOME MEASURES Cone beam computed tomography (CBCT) scans were compared in multiple coronal sections and were evaluated for linear and angular septal deviation, inferior turbinate hypertrophy, and linear and 2-dimensional airway area. RESULTS There were no significant differences in linear or angular septal deviation, inferior turbinate area, linear stenosis, or airway area between NAM- and non-NAM-treated patients. CONCLUSIONS NAM effectively molds the external nasal cartilage and structures but may have limited effects on internal nasal structures.
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Affiliation(s)
- Jonathan P Massie
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Karl Bruckman
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - William J Rifkin
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Christopher M Runyan
- 2 Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Pradip R Shetye
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Barry Grayson
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Roberto L Flores
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
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Fuchigami T, Kimura N, Kibe T, Tezuka M, Amir MS, Suga H, Takemoto Y, Hashiguchi M, Maeda-Iino A, Nakamura N. Effects of pre-surgical nasoalveolar moulding on maxillary arch and nasal form in unilateral cleft lip and palate before lip surgery. Orthod Craniofac Res 2017; 20:209-215. [PMID: 28921849 DOI: 10.1111/ocr.12199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the effects of pre-surgical nasoalveolar moulding (PNAM) on the maxillary arch and nasal form in patients with unilateral cleft lip and palate (UCLP). SETTING AND SAMPLE POPULATION This is a retrospective case series study. The subjects were infants with complete UCLP who were treated with PNAM (n = 18) at Kagoshima University Medical and Dental Hospital (Japan) between 2006 and 2013. MATERIAL AND METHODS Maxillary dental casts and facial photographs were taken at the time of the first visit and immediately prior to lip surgery to evaluate the maxillary arch and nasal form changes. The dental casts were scanned with a laser scanner, and changes in the 3-Dimensional coordinates of anatomical landmarks and alveolar cleft width were analysed. Moreover, we investigated the correlation between the changes in the maxillary alveolar arch and nasal form. RESULTS Regarding the maxillary alveolar arch form, the anterior points of the major segment had moved significantly to the cleft side just prior to the time of lip repair, and the alveolar cleft width was significantly decreased. For nasal form, the inclination and displacement of the columella were significantly improved. The improvement of columella inclination was moderately correlated with the posterior movement of the anterior points of the major segment. CONCLUSIONS These findings indicate that PNAM for infants with UCLP enhanced symmetry in the maxillary alveolar arch and nasolabial form. In addition, the posterior movement of the anterior points of the maxillary alveolar arch was correlated with the improvement of columella deformation.
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Affiliation(s)
- T Fuchigami
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - N Kimura
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - T Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Tezuka
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M S Amir
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Airlangga University, Surabaya, Indonesia
| | - H Suga
- Department of Pediatric Dentistry, Field of Developmental Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Y Takemoto
- Department of Pediatric Dentistry, Field of Developmental Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Hashiguchi
- Department of Pediatric Dentistry, Field of Developmental Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - A Maeda-Iino
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - N Nakamura
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Chou PY, Hallac RR, Ajiwe T, Xie XJ, Liao YF, Kane AA, Park YJ. The role of Nasoalveolar molding: A 3D Prospective analysis. Sci Rep 2017; 7:9901. [PMID: 28852137 PMCID: PMC5575095 DOI: 10.1038/s41598-017-10435-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/09/2017] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Pang-Yun Chou
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rami R Hallac
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic Surgery, UT Southwestern, Dallas, TX, United States
| | - Tochi Ajiwe
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States
| | - Xian-Jin Xie
- Department of Clinical Sciences & Simmons Comprehensive Cancer Center, UT Southwestern, Dallas, Texas, United States
| | - Yu-Fang Liao
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alex A Kane
- Analytical Imaging and Modeling Center, Children's Health, Dallas, Texas, United States.,Department of Plastic Surgery, UT Southwestern, Dallas, TX, United States
| | - Yong Jong Park
- Department of Orthodontics, Children's Health Children's Medical Center, Dallas, Texas, United States.
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Maillard S, Retrouvey JM, Ahmed MK, Taub PJ. Correlation between Nasoalveolar Molding and Surgical, Aesthetic, Functional and Socioeconomic Outcomes Following Primary Repair Surgery: a Systematic Review. J Oral Maxillofac Res 2017; 8:e2. [PMID: 29142654 PMCID: PMC5676312 DOI: 10.5037/jomr.2017.8302] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair. MATERIAL AND METHODS A literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals ("Cleft Palate-Craniofacial Journal", "Plastic and Reconstructive Surgery Journal" and "American Journal of Orthodontics and Dentofacial Orthopaedic") from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology. RESULTS Of the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking. CONCLUSIONS Based on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.
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Affiliation(s)
- Sophie Maillard
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Jean-Marc Retrouvey
- Division of Orthodontics, Faculty of Dentistry, McGill University, Montreal, QuebecCanada.
| | - Mairaj K. Ahmed
- Departments of Dentistry/Oral/Maxillofacial Surgery, Otolaryngology, and Surgery. Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
| | - Peter J. Taub
- Departments of Dentistry, Pediatrics, Surgery and Medical Education, Mount Sinai Cleft and Craniofacial Center, Icahn School of Medicine at Mount Sinai, New YorkUSA.
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Vyloppilli S, Krishnakumar KS, Sayd S, Latheef S, Narayanan SV, Pati A. Postoperative alar base symmetry in complete unilateral cleft lip and palate:A prospective study. J Plast Reconstr Aesthet Surg 2017; 70:1614-1619. [PMID: 28676318 DOI: 10.1016/j.bjps.2017.05.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022]
Abstract
In the evolution of cleft lip repair, there have been continuous attempts to minimize local trauma and to improve lip and nasal appearances. In order to obtain an aesthetically balanced development of midface, the primary surgical correction of the nasolabial area is of paramount importance. In this study, the importance of a back-cut extending cephalically above the inferior turbinate at the mucocutaneous junction which elevates the nostril floor on the cleft side for the purpose of achieving symmetry of the alar bases are analyzed by pre and postoperative photographic anthropometry. This study comprised of fifty cases of the unilateral complete cleft lip. At the time of surgery, the patient age ranged from 3-9 months. The surgeries, performed by a single surgeon, employed the standard Millard technique, incorporating Mohler modifications of lip repair. Anthropometric analysis revealed that the preoperative mean difference between the normal side and the cleft side was 0.2056 with a standard deviation of 0.133. In the postoperative analysis, the mean difference was reduced to 0.0174 with a standard deviation of 0.141. The paired t-test showed that the p-value is <0.001, indicating high statistical significance. To conclude, in complete unilateral cleft lip and palate, the geometrically placed nasal back-cut incision has a definite role in the correction of the alar base symmetry during primary surgery.
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Affiliation(s)
- Suresh Vyloppilli
- Malankara Orthodox Syrian Church Medical College & Hospital, Kolenchery, Ernakulam, India
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28
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Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and palate orthopedics: an overview. Clin Cosmet Investig Dent 2017; 9:53-59. [PMID: 28615974 PMCID: PMC5459959 DOI: 10.2147/ccide.s129598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.
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Affiliation(s)
| | - Waeil Batwa
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alex Cash
- Cleft Lip and Palate Orthodontics, Queen Victoria NHS Foundation Trust, South Thames Cleft Service, London, UK
| | - Zuhair A Murshid
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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29
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Crerand CE, Conrad AL, Albert M, Bellucci CC, Heppner CE, Sheikh F, Woodard S, Kapp-Simon KA. The Americleft Psychosocial Outcomes Project: A Multicenter Approach to Advancing Psychosocial Outcomes for Youth With Cleft Lip and Palate. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 5:65-76. [PMID: 31511822 PMCID: PMC6738562 DOI: 10.1037/cpp0000172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cleft lip and/or palate (CL/P) are among the most common of all birth defects. Habilitation requires multiple surgeries and other therapies throughout childhood and adolescence. While multidisciplinary care is recommended, there is a great deal of variation in treatment protocols for this condition. There is ample evidence that children with CL/P are at risk for psychosocial problems. However, to date, few studies have systematically investigated parent and patient self-reported psychosocial and quality of life (QOL) outcomes for children with CL/P as they relate to variations in treatment protocols. The Americleft Outcomes project was initiated to demonstrate and document outcomes to be expected with team care, and to define the key features or characteristics of various team treatment protocols and procedures that are associated with more or less favorable/desirable outcomes. This article will describe the psychosocial component of the Americleft Outcomes project that is aimed at developing a protocol that will allow cross team assessment of psychosocial outcomes for children with CL/P in relationship to the treatments they received. The protocol will be detailed along with a description of the process and considerations that were instrumental in the development of the project. Stakeholder input about the project's perceived relevance to families of children with CL/P will be reported. The paper concludes with a discussion of the challenges encountered with this project, clinical implications, and future directions.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine
| | - Amy L Conrad
- The Stead Family Department of Pediatrics, Division of Pediatric Psychology, University of Iowa Children's Hospital
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic, Surgery, Shriners Hospitals for Children-Chicago, Illinois, and Craniofacial Center, Department of Surgery, University, of Illinois at Chicago
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric, Plastic Surgery, Shriners Hospitals for Children-Chicago
| | - Celia E Heppner
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's, Medical Center, Dallas, Texas, and University of Texas, Southwestern Medical Center
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago and Craniofacial Center, Department of Surgery, University of Illinois at Chicago
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30
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Presurgical Nasoalveolar Molding Therapy Using Figueroa's NAM Technique in Unilateral Cleft Lip and Palate Patients: A Preliminary Study. J Clin Pediatr Dent 2017; 40:410-6. [PMID: 27617383 DOI: 10.17796/1053-4628-40.5.410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the results of nasoalveolar molding (NAM) in the treatment of patients with unilateral cleft lip and palate using a modified technique in a South Indian population. STUDY DESIGN The design was a prospective study with blinded measurements. The sample constituted 10 complete unilateral cleft lip and palate (UCLP) patients who underwent NAM therapy by the same operator. Direct extra and intra oral anthropometric measurements were done using a digital vernier caliper before and after NAM therapy. A photographic evaluation was also done to rate the nasal deformity post NAM therapy. The differences between measurements were statistically analyzed using paired t tests. RESULTS The extra oral measurements revealed a statistically significant increase in bi-alar width, columellar length and width. The intraoral measurements demonstrated a statistically significant reduction in anterior alveolar cleft width. There was also a significant increase in arch width and greater and lesser segments length. All cases were rated as improved by the surgeons in photographic analysis. CONCLUSION The study has quantitatively shown that the modified NAM therapy improved nasal asymmetry by columellar lengthening and effectively molded the maxillary alveolar arch.
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31
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Rodman RE, Tatum S. Controversies in the Management of Patients with Cleft Lip and Palate. Facial Plast Surg Clin North Am 2016; 24:255-64. [DOI: 10.1016/j.fsc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hopkins EE, Gazza E, Marazita ML. Parental experience caring for cleft lip and palate infants with nasoalveolar moulding. J Adv Nurs 2016; 72:2413-22. [PMID: 27144651 DOI: 10.1111/jan.12994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore the experience of parents caring for an infant with a cleft lip and palate receiving nasoalveolar moulding. BACKGROUND Nasoalveoral moulding is a pre-surgical orthopedic appliance used to approximate an infant's cleft lip and palate, mould the nose and reduce surgical correction. Use of nasoalveolar moulding can be intensive, costly and lengthy requiring parental commitment to the process since it involves several months of weekly visits for appliance adjustment. Although extensive research has been conducted on surgical outcomes after use, little evidence exists pertaining to parental experiences caring for an infant undergoing the nasoalveolar moulding treatment process. DESIGN The qualitative design phenomenology was used to best capture parents' lived experiences. METHODS Eight mothers and four fathers participated in informal, semi-structured interviews during the months of April-May 2010. RESULTS Four themes were identified: (1) You do what you have to do; (2) We weren't left alone in the dark; (3) It's just amazing to see the difference; and (4) It's like nothing ever happened. Findings indicated that despite some difficulties, parents' were dedicated to the treatment process and expressed the benefits exceeded any additional work nasoalveolar moulding required. CONCLUSION Multiple recommendations to assist parents with the nasoalveolar moulding treatment process were identified. Improving nasoalveolar moulding education and providing support can substantially improve challenges that are experienced by parents throughout this process - strengthening the importance of their role for successful nasoalveolar moulding outcomes.
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Affiliation(s)
| | - Elizabeth Gazza
- University of North Carolina Wilmington, North Carolina, USA
| | - Mary L Marazita
- Department of Oral Biology, School of Dental Medicine, Pittsburgh, Pennsylvania, USA.,Center for Craniofacial and Dental Genetics, School of Dental Medicine, Pittsburgh, Pennsylvania, USA.,Department of Human Genetics, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Zheng Y, Zhang D, Qin T, Wu G. Correction of nasal deformity in infants with unilateral cleft lip and palate using multiple digital techniques. J Prosthet Dent 2015; 115:788-91. [PMID: 26724850 DOI: 10.1016/j.prosdent.2015.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/07/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022]
Abstract
Presurgical correction of severe nasal deformities before cheiloplasty is often recommended for infants with cleft lip and palate. This article describes an approach for the computer-aided design and fabrication of a nasal molding stent. A 3-dimensional photogrammetric system was used to obtain the shape information of the nosewing that was then built as the nostril support for the nasal molding stent. The stent was fabricated automatically with a rapid prototyping machine. This technique may be an alternative approach to presurgical nasal molding in the clinic. Moreover, the patient's nasal morphology can be saved as clinical data for future study.
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Affiliation(s)
- Yaqi Zheng
- Resident, State Key Laboratory of Military Stomatology, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi, China
| | - Dapeng Zhang
- Resident, State Key Laboratory of Military Stomatology, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi, China
| | - Tian Qin
- Resident, State Key Laboratory of Military Stomatology, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi, China
| | - Guofeng Wu
- Associate Professor, State Key Laboratory of Military Stomatology, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi, China.
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34
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Rubin MS, Clouston S, Ahmed MM, M Lowe K, Shetye PR, Broder HL, Warren SM, Grayson BH. Assessment of presurgical clefts and predicted surgical outcome in patients treated with and without nasoalveolar molding. J Craniofac Surg 2015; 26:71-5. [PMID: 25534051 DOI: 10.1097/scs.0000000000001233] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.
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Affiliation(s)
- Marcie S Rubin
- From the *Department of Plastic Surgery, New York University Langone Medical Center, New York, NY; †Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY; ‡Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY
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35
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Gandedkar NH, Kiat CC, Kanesan P, Lee WC, Chen PY, Leng Yeow VK. Presurgical nasoalveolar molding therapy in cleft lip and palate individuals: Case series and review. APOS TRENDS IN ORTHODONTICS 2015. [DOI: 10.4103/2321-1407.163424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The nasoalveolar molding (NAM) therapy is advocated to reduce the severity of alveolar cleft and nasal deformity. NAM therapy has demonstrated to be an effective method for reducing cleft and improve nose anatomy. This paper presents a case report of three cleft lip and palate individuals treated with NAM therapy. Furthermore, the paper highlights the advantages of NAM therapy along with an enumeration of literature suggesting in favor of NAM therapy and otherwise. Regardless of controversies and divergent views involved with NAM therapy, the immediate success of NAM therapy facilitating primary lip repair surgery cannot be under-emphasized.
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Affiliation(s)
- Narayan H. Gandedkar
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Chng Chai Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Palaniselvam Kanesan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Wen Cong Lee
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Por Yong Chen
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
| | - Vincent Kok Leng Yeow
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cleft and Craniofacial Center and Dental Service, KK Women’s and Children’s Hospital, Bukit Timah - 229 899, Singapore
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36
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Yu Q, Gong X, Shen G. CAD presurgical nasoalveolar molding effects on the maxillary morphology in infants with UCLP. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:418-26. [PMID: 24035109 DOI: 10.1016/j.oooo.2013.06.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/26/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated the effectiveness of computer-aided design-nasoalveolar molding (CAD-NAM) on maxillary alveolar morphology in infants with unilateral cleft lip and palate (UCLP). METHODS 15 infants with UCLP treated by CAD-NAM therapy composed the treatment group, and the control group consisted of 15 infants with non-presurgically treated UCLP. The maxillary morphology was analyzed by Rapidform XOR3 software. Differences in all variables pre- and post-CAD-NAM were discussed. RESULTS Significant difference was found in arch length, cleft gap, labial frenum deviation, A-X, A'-X, and alveolus height on both sides pre- and post-CAD-NAM. CONCLUSIONS This study suggests a trend toward morphological improvement in maxillary alveoli of infants with UCLP treated with CAD-NAM. The CAD-NAM effectively reduced the cleft gap, corrected the maxilla midline, and improved the sagittal length of the maxilla. The alveolar height decreased significantly after the treatment, which indicated that the traction force of the appliance may have obstructive effects on the vertical growth of the alveolar bone.
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Affiliation(s)
- Quan Yu
- Assistant Professor, Department of Orthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology
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Grayson BH, Garfinkle JS. Early cleft management: the case for nasoalveolar molding. Am J Orthod Dentofacial Orthop 2014; 145:134-42. [PMID: 24485726 DOI: 10.1016/j.ajodo.2013.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barry H Grayson
- Associate professor of surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Judah S Garfinkle
- Assistant professor of plastic surgery and orthodontics, and director of Craniofacial Orthodontics, Oregon Health and Science University, Portland; private practice, Portland, Ore.
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Kuijpers MAR, Chiu YT, Nada RM, Carels CEL, Fudalej PS. Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review. PLoS One 2014; 9:e93442. [PMID: 24710215 PMCID: PMC3977868 DOI: 10.1371/journal.pone.0093442] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Data sources Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. Study selection We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction Independent extraction of data and quality assessments were performed by two observers. Results Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041
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Affiliation(s)
- Mette A. R. Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Yu-Ting Chiu
- Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Rania M. Nada
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carine E. L. Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piotr S. Fudalej
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland
- Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic
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Abstract
Management of cleft lip and palate requires a unique understanding of the various dimensions of care to optimize outcomes of surgery. The breadth of treatment spans multiple disciplines and the length of treatment spans infancy to adulthood. Although the focus of reconstruction is on form and function, changes occur with growth and development. This review focuses on the surgical management of the primary cleft lip and nasal deformity. In addition to surgical treatment, the anatomy, clinical spectrum, preoperative care, and postoperative care are discussed. Principles of surgery are emphasized and controversies are highlighted.
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Affiliation(s)
- Raymond Tse
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
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Nemes B, Fábián G, Nagy K. Management of Prominent Premaxilla in Bilateral Cleft Lip and Alveolus. Cleft Palate Craniofac J 2013; 50:744-6. [DOI: 10.1597/12-019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our aim was to describe the early management protocol of the prominent premaxilla in bilateral cleft lip and alveolus and its rationale, as used in the Cleft Centre at the 1st Department of Pediatrics and at the Department of Pedodontics and Orthodontics at the Semmelweis University Budapest. The non-surgical and surgical procedures included lip taping, nasoalveolar molding, lip adhesion and definitive one-stage lip closure. With this treatment sequence, arch management was satisfactory and at the time of the definitive lip closure the position of the premaxilla did not interfere with adequate surgical repair.
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Affiliation(s)
- Bálint Nemes
- Department of Pedodontics and Orthodontics, Semmelweis University, Budapest, Hungary
| | - Gábor Fábián
- Department of Pedodontics and Orthodontics, Semmelweis University, Budapest, Hungary
| | - Krisztián Nagy
- Department of Pediatrics, Semmelweis University Budapest, and Cleft & Craniofacial Centre and at the Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium
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A 3-Dimensional Anthropometric Evaluation of Facial Morphology Among Chinese and Greek Population. J Craniofac Surg 2013; 24:e353-8. [DOI: 10.1097/scs.0b013e3182902e5d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg 2013; 131:62e-71e. [PMID: 23271555 DOI: 10.1097/prs.0b013e318267d4a5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term. METHODS A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch. RESULTS The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects. CONCLUSIONS Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Discussion: Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg 2013; 131:72e-74e. [PMID: 23271556 DOI: 10.1097/prs.0b013e3182729f80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Ladeira PRS, Alonso N. Protocols in cleft lip and palate treatment: systematic review. PLASTIC SURGERY INTERNATIONAL 2012; 2012:562892. [PMID: 23213503 PMCID: PMC3503280 DOI: 10.1155/2012/562892] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022]
Abstract
Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.
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Affiliation(s)
| | - Nivaldo Alonso
- Division of Burns and Plastic Surgery, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Rua Afonso Brás, 473 cj 65 Vila Nova Conceição, 04511-000 São Paulo, SP, Brazil
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