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Likitkulthanaporn A, Boonpratham S, Honglertnapakul Y, Saengfai NN, Chaweewannakorn C, Jongkhum N, Peanchitlertkajorn S. Effects of nasoalveolar molding on nasolabial aesthetics in patients with cleft lip and palate during pre-adolescence: A systematic review and meta-analysis of retrospective studies. Orthod Craniofac Res 2024; 27:350-363. [PMID: 38288677 DOI: 10.1111/ocr.12762] [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: 10/21/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 05/08/2024]
Abstract
This study aims to analyze long-term effects of nasoalveolar molding (NAM) as a part of cleft primary management protocols on nasolabial aesthetics for patients with non-syndromic cleft lip and palate by conducting a systematic review and meta-analysis. Six electronic databases and two journals were searched up to July 2023. Studies comparing nasolabial outcomes between NAM and non-NAM protocols were selected for further analysis. Nasolabial aesthetics were the outcome of interest. Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis and subgroup analysis were performed. Seven retrospective cohort studies were selected for a qualitative review and four for a quantitative analysis. The risk of bias assessment was moderate for most studies. Only studies utilizing the Asher-McDade rating (AMR) were included for meta-analyses. The protocols with NAM exhibited a significantly lower AMR score for vermillion border than other protocols. AMR scores for nasal form and nasal symmetry from protocols with NAM were significantly lower than protocols without any pre-surgical infant orthopaedics (PSIO) but not significantly different from protocols with other PSIO techniques. The AMR score for nasolabial profile from protocols with NAM was not significantly different from other protocols. However, subgroup analysis demonstrated that protocol combining NAM and primary rhinoplasty significantly lowered AMR scores for nasal form, nasal symmetry and nasolabial profile. For patients with unilateral cleft lip with or without palate (UCLP), this study found that a protocol combining NAM and primary rhinoplasty improved nasolabial outcomes while a protocol with NAM alone offered only limited benefits. For patients with BCLP, the available evidence remains inconclusive. Performing NAM in combination with primary rhinoplasty improves nasolabial aesthetics in patients with UCLP. PROSPERO (CRD4202128384).
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Affiliation(s)
| | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | | | - Nannapat Jongkhum
- Department of Orthodontics, Faculty of Dentistry, Mahidol 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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Alrubaiaan R, Nair B, Amir-Rad F, Aljanahi M, Kumar S V, Prasad S. Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives. Cleft Palate Craniofac J 2024:10556656241233115. [PMID: 38389436 DOI: 10.1177/10556656241233115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment. DESIGN PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019). RESULTS Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits. CONCLUSION Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.
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Affiliation(s)
- Raed Alrubaiaan
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Bhavana Nair
- Guidance & Counseling Office, Student Life, Mohammed Bin Rashid University of Medicine and HealthSciences, Dubai, United Arab Emirates
| | - Fatemeh Amir-Rad
- Department of Prosthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - May Aljanahi
- Program Director, Dental Internship, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Vijay Kumar S
- Department of Public Health Dentistry, Amrita School of Dentistry, Amritha Vishwa Vidyapeetham, Kochi , Kerala, India
| | - Sabarinath Prasad
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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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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Oday R, Abid M. Accuracy and Retention of Molding Plates Used for Infants with Cleft Lip and Palate Fabricated from Different Materials: A Cross-Sectional Clinical Study. Cleft Palate Craniofac J 2023:10556656231202592. [PMID: 37801511 DOI: 10.1177/10556656231202592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES The study aimed to comparatively assess the accuracy and retention of molding plates made of polyethylene terephthalate modified with glycol (PET-G) and polymethyl methacrylate (PMMA) materials, while also investigating the effect of adhesive addition on retention. DESIGN A cross-sectional clinical study. PATIENTS/SETTING The study included 30 infants diagnosed with non-syndromic cleft lip and palate (16 unilateral, 14 bilateral). Two molding plates were fabricated for each infant, and their accuracy and retention were evaluated. The data were analyzed using independent t-tests, Mann-Whitney U tests, and Wilcoxon rank tests. MAIN OUTCOME MEASURES Accuracy: The accuracy of the molding plates was assessed by measuring the virtual gap between the inner surface of the plates and their working cast using Exocad software. The accuracy was evaluated in different regions (anterior, middle, and posterior) and compared between PET-G and PMMA materials. Retention: The retention of the molding plates was measured using a digital force gauge, which recorded the force required to dislodge the plates from the infant's mouth. The retention was compared between PET-G and PMMA materials, as well as the effect of adhesive addition on retention. Overall adaptation; PET-G plates showed a significantly smaller gap (mean= 0.264 ±0.106) compared to PMMA (mean= 0.362 ±0.130). Region-specific adaptation: PET-G plates demonstrated better accuracy in all regions (means of anterior =0.246, middle =0.262, posterior =0.282 µm). Significant differences in accuracy were observed in the middle and posterior regions compared to PMMA. Retention assessment revealed that the PET-G groups (with or without adhesive) exhibited significantly higher retention compared to the PMMA groups (P<0.01). CONCLUSION PET-G plates demonstrated superior accuracy and retention compared to PMMA, with a significant difference observed in both accuracy and retention. Furthermore, the addition of denture adhesive had a positive effect on retention for both materials.
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Affiliation(s)
- Raghad Oday
- Department of Orthodontic, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Mushriq Abid
- Department of Orthodontic, College of Dentistry, University of Baghdad, Baghdad, Iraq
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El-Ashmawi NA, Fayed MMS, El-Beialy A, Fares AE, Attia KH. Evaluation of Facial Esthetics Following NAM Versus CAD/NAM in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial. Cleft Palate Craniofac J 2023; 60:1078-1089. [PMID: 35422139 DOI: 10.1177/10556656221093176] [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: 11/16/2022] Open
Abstract
OBJECTIVE The aim is to compare the facial esthetics following nasoalveolar molding (NAM) versus computer-aided design NAM (CAD/NAM) in patients with bilateral cleft lip/palate (CLP). DESIGN The trial is a randomized comparative trial with a 1:1 allocation ratio. PARTICIPANTS Thirty infants with bilateral complete cleft lip and palate were recruited. INTERVENTIONS Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create a series of modified virtual models, which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the intraoral plates following the Grayson method. The study lasted for 4 months. MAIN OUTCOMES The assessment of the changes observed in the interlabial gap and nasolabial esthetics was done using standardized 2-dimensional photographs. The correlation between dental arch changes and extraoral facial esthetics was studied. RESULTS Both modalities showed improvement in nasolabial esthetics before the lip surgery. No statistically significant difference was found between NAM and CAD/NAM groups in any of the assessed variables. CONCLUSIONS Both interventions were effective in the management of infants with bilateral CLP.
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Affiliation(s)
- Noha A El-Ashmawi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mona M Salah Fayed
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Amr El-Beialy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ahmed E Fares
- Department of Pediatric Surgery, Faculty of Medicine, Fayoum University Hospital, Fayoum, Egypt
| | - Khaled H Attia
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Long RE, Hathaway RR. Practice-based Evidence from Comparative Effectiveness Research to Inform Evidence-based Practice. Cleft Palate Craniofac J 2023:10556656231198661. [PMID: 37649309 DOI: 10.1177/10556656231198661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Ross E Long
- Lancaster Cleft Palate Clinic, Lancaster, PA, USA
| | - Ronald R Hathaway
- Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
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Gillgrass T. The orthodontic management of patients with cleft lip and palate: from birth to the late mixed dentition. Br Dent J 2023; 234:873-880. [PMID: 37349434 DOI: 10.1038/s41415-023-5955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 06/24/2023]
Abstract
This is the first of two papers outlining the orthodontic management of patients with cleft lip and palate. This paper will review orthodontic input into children with cleft lip and palate from birth to the late mixed dentition before definitive orthodontics. It will emphasise the importance of timing in alveolar bone grafting, the role of the general dental practitioner and the impact of timing on definitive orthodontic outcome.
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Affiliation(s)
- Toby Gillgrass
- Cleft Surgical Service for Scotland & Glasgow Dental Hospital and School, Glasgow, United Kingdom.
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Batra P, Gribel BF, Abhinav BA, Raghavan S, Arora A. A comparative evaluation of presurgical infant orthopedics of modified Grayson's technique with clear aligners incorporating a nasal elevator in patients with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:714-727. [PMID: 35981905 DOI: 10.1016/j.ajodo.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the differences between 2 methods of presurgical infant orthopedics: the modified Grayson's technique and a new technique using clear aligners in patients with complete unilateral cleft lip and palate. METHODS For this prospective comparative cohort study, 30 patients were divided into 2 groups: group A (modified Grayson technique) and group B (clear aligner trays), with 15 patients each. Scanned cast measurements were taken before and after treatment and evaluated using an appropriate 3-dimensional software assessing treatment changes in the alveolus (eg, reduction of width between major and minor segment, angulation change of each respective segment [intragroup and intergroup, respectively]). This was supplemented with standardized anterioposterior, Worms-eye view, and profile photographs assessing changes in columellar angle, nostril width, height, nasolabial angle, and soft-tissue cleft gap. Furthermore, the number of visits for each patient group was also tabulated and assessed. The differences were compared using the independent t test and Mann-Whitney U test for the respective parameters. RESULTS Groups A and B showed similar posttreatment changes, with no overt significant differences. However, there was a statistically significant difference in the number of visits (P <0.05), with group B having much lower visits to the center than group A. The posttreatment values matched previously established growth reference values. The analysis of photographic measurements showed improved nasal asymmetry in both groups without any significant difference. CONCLUSIONS Because there was no difference in the treatment results between the 2 methods and a reduction in the number of required patient visits, presurgical infant orthopedics via clear aligners could pave the way for a more patient-efficient approach.
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Affiliation(s)
- Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - B A Abhinav
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - Anika Arora
- Manav Rachna Dental College, Faridabad, Haryana, India
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Current Presurgical Infant Orthopedics Practices Among American Cleft Palate Association–Approved Cleft Teams in North America. J Craniofac Surg 2022; 33:2522-2528. [DOI: 10.1097/scs.0000000000008790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 12/23/2022] Open
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ElNaghy R, Amin SA, Hasanin M. Evaluating the accuracy of intraoral direct digital impressions in 2 infants with unilateral cleft lip and palate compared with digitized conventional impression. Am J Orthod Dentofacial Orthop 2022; 162:403-409. [DOI: 10.1016/j.ajodo.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
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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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Continuous circular closure in unilateral cleft lip and plate repair in one surgery. J Craniomaxillofac Surg 2021; 50:76-85. [PMID: 34896005 DOI: 10.1016/j.jcms.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/05/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022] Open
Abstract
The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.
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Time-Driven, Activity-Based Costing of Presurgical Infant Orthopedics: A Critical Component of Establishing Value of Latham Appliance and Nasoalveolar Molding. Plast Reconstr Surg 2021; 147:444-454. [PMID: 33620939 DOI: 10.1097/prs.0000000000007669] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Value-based health-care reform requires assessment of outcomes and costs of medical interventions. In cleft care, presurgical infant orthopedics is still being evaluated for clinical benefits and risks; however, the cost of these procedures has been largely ignored. This study uses robust accounting methods to quantify the cost of providing two types of presurgical infant orthopedics: Latham appliance treatment and nasoalveolar molding. METHODS This is a prospective study of patients with nonsyndromic cleft lip and/or palate who underwent treatment with presurgical infant orthopedics from 2017 to 2019 at two academic centers. Costs were measured using time-driven activity-based costing. Personnel costs, facility costs (operating room, clinic, and inpatient ward), and equipment costs were included. Travel expenses were incorporated as an estimate of direct costs borne by the family, but indirect costs (e.g., time off from work) were not considered. RESULTS Twenty-three patients were treated with Latham appliance treatment and 14 were treated with nasoalveolar molding. For Latham appliance treatment, average total cost was $7553 per patient ($1041 for personnel, $637 for equipment, $4871 for facility, and $1004 for travel over 6.5 visits). Unilateral and bilateral costs were $6891 and $8860, respectively. For nasoalveolar molding, average cost totaled $2541 ($364 for personnel, $151 for equipment, $300 for facility, and $1726 for travel over 13 visits); $2120 for unilateral and $3048 for bilateral treatment. CONCLUSIONS The major difference in cost is attributable to operative placement of the Latham device. Travel cost for nasoalveolar molding is often higher because of frequent clinical encounters required. Future investigation should focus on whether outcomes achieved by presurgical infant orthopedics justify the $2100 to $8900 expenditure for these adjunctive procedures.
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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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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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El-Ashmawi NA, Fayed MMS, El-Beialy A, Attia KH. Evaluation of the Clinical Effectiveness of Nasoalveolar Molding (NAM) Using Grayson Method Versus Computer-Aided Design NAM (CAD/NAM) in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial. Cleft Palate Craniofac J 2021; 59:377-389. [PMID: 33557610 DOI: 10.1177/1055665621990152] [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: 11/16/2022] Open
Abstract
OBJECTIVE The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer-aided design NAM (CAD/NAM) in patients with bilateral clefts. DESIGN The trial is a randomized comparative trial with 1:1 allocation ratio. PARTICIPANTS Thirty infants with bilateral complete cleft lip and palate were recruited. INTERVENTIONS Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months. MAIN OUTCOMES The primary outcome was to evaluate the changes in the intersegment cleft gap. Secondary outcomes included the analysis of the maxillary arch in transverse, anteroposterior, and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods. RESULTS Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99 mm (-3.79 to 0.19, P = .03) as compared to the NAM treatment. No differences were found between groups in the transverse and vertical maxillary arch changes. CONCLUSIONS Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment.
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Affiliation(s)
- Noha A El-Ashmawi
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.,Department of Orthodontics and Pediatric Dentistry, University of Michigan, MI, USA
| | - Mona M Salah Fayed
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Amr El-Beialy
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Khaled H Attia
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Gibson TL, Grayson BH, Shetye PR. Sociodemographic Predictors of Treatment Success and Difficulty in Nasoalveolar Molding. Cleft Palate Craniofac J 2020; 58:378-385. [PMID: 32840124 DOI: 10.1177/1055665620949791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess social and demographic influences on caregiver success and difficulty with nasoalveolar molding (NAM). DESIGN Retrospective review identified patients who began NAM between April 22, 2013, and April 18, 2017, at the New York University Langone Medical Center. Records were reviewed, and the following sociodemographic data retrieved: parental marital status, parental ages, number of siblings, distance traveled to clinic, insurance coverage, concurrent medical conditions, and need for an interpreter. PATIENTS Patients were included if complete charting was available; 106 patients met the inclusion criteria; 79 patients with unilateral and 27 with bilateral clefts. OUTCOME MEASURES Chart entries indicating incorrect appliance usage, emergency visits, phone calls, and noncompliance were recorded. Alveolar cleft gap closure was measured on pre- and posttreatment models in unilateral cases. Multiple regression analyses were performed to assess the influence of social variables on these outcomes. RESULTS Alveolar cleft gap closure was 7.2 ± 3.0 mm, or 78.5% ± 19.1%. Cleft closure increased with paternal age by 0.33 mm (P = .007) or 2.0% (P = .017) per year, decreased with maternal age by 0.29 mm (P = .041) per year, and increased in married and partnered parents by 39% (P = .018). Incorrect appliance usage averaged 0.62 fewer instances for married and partnered parents (P = .018) and 0.43 fewer for those with private insurance (P = .019). CONCLUSIONS Alveolar cleft gap closure was more successful for older fathers, younger mothers, and married couples. Married couples were also less likely to experience treatment difficulties such as incorrect appliance usage or inadequate duration of wear, as were those with private insurance coverage.
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Affiliation(s)
- Travis L Gibson
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Barry H Grayson
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Pradip R Shetye
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
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20
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Yilmaz HN, Abuhan E. Maternal and paternal anxiety levels through primary lip surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:478-483. [PMID: 32828994 DOI: 10.1016/j.jormas.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/13/2020] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to evaluate the anxiety levels of the parents of infants with cleft lip and palate (CLP) before and after primary lip surgery. MATERIALS AND METHOD Forty mothers (mean ages: 31.9 ± 6.16 years) and 40 fathers (mean ages: 34.6 ± 5.91 years) of infants with CLP were included in this study. They were asked to answer the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Spielberger's State-Trait Anxiety Inventory (STAI) just 1 h before the primary lip surgery (T0) and 1 month after (T1) surgery. Student t-test and Mann-Whitney U test were used for inter-group comparison, the paired-sample t was used for the intra-group comparisons (p < 0.05). RESULTS There were no statistically significant differences for the comparisons of state (STAI-S) and trait (STAI-T) anxiety or APAIS scores between the parents. While state anxiety scores of the mothers increased significantly post-surgically, APAIS scores showed significant decreases in both parents (p < 0.05). APAIS scores of the fathers with bilateral CLP infants were significantly higher (p < 0.05) than the fathers of unilateral ones. The parents with local anesthesia experience showed significantly lower APAIS scores (p < 0.05). A negative correlation was present between maternal age and STAI-T, whereas a positive correlation was present between paternal age and the anxiety. CONCLUSIONS The anxiety levels of the parents were similar. Parents asked for more information about the anesthesia than the surgery, therefore communication with the anesthesiologist in the preoperative period is important. Routine assessment of parents' stress and psychosocial support should be provided by the cleft team.
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Affiliation(s)
- Hanife Nuray Yilmaz
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Başıbüyük Street 9/3, 34854, Başıbüyük, Maltepe, Istanbul, Turkey.
| | - Ece Abuhan
- Dentistry Specialty Student, Department of Orthodontics, Faculty of Dentistry, Marmara University, Başıbüyük Street 9/3, 34854, Başıbüyük, Maltepe, Istanbul, Turkey.
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21
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Bous RM, Kochenour N, Valiathan M. A novel method for fabricating nasoalveolar molding appliances for infants with cleft lip and palate using 3-dimensional workflow and clear aligners. Am J Orthod Dentofacial Orthop 2020; 158:452-458. [PMID: 32709578 DOI: 10.1016/j.ajodo.2020.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices. METHODS A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage. RESULTS We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits. CONCLUSIONS NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.
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Affiliation(s)
- Rany M Bous
- Mt Sinai-Dr Edward Reiter Fellowship Program, Craniofacial and Special Care Orthodontics, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Nicholas Kochenour
- James A. Lehman Jr. MD, Craniofacial Center, Akron Children's Hospital, Akron, Ohio
| | - Manish Valiathan
- Mt Sinai-Dr Edward Reiter Fellowship Program, Craniofacial and Special Care Orthodontics, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
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22
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Alfonso AR, Ramly EP, Kantar RS, Wang MM, Eisemann BS, Staffenberg DA, Shetye PR, Flores RL. What Is the Burden of Care of Nasoalveolar Molding? Cleft Palate Craniofac J 2020; 57:1078-1092. [PMID: 32500737 DOI: 10.1177/1055665620929224] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers. SEARCH METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM. ELIGIBILITY CRITERIA Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included. DATA COLLECTION AND ANALYSIS Study selection was performed by 2 independent reviewers. RESULTS The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias. CONCLUSION Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.
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Affiliation(s)
- Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Maxime M Wang
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Bradley S Eisemann
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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23
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Heike CL, Albert M, Aspinall CL, Bautista S, Bellucci CC, Kapp-Simon KA, Mecham S, Patrick DL, Rosenberg J, Siebold B, Stueckle LP, Edwards TC. Development of an Outcome Measure of Observable Signs of Health and Well-Being in Infants With Orofacial Clefts. Cleft Palate Craniofac J 2020; 57:1266-1279. [PMID: 32468839 DOI: 10.1177/1055665620922105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To develop an outcomes instrument that assesses observations that can be reliably reported by caregivers and can be used to assess health of infants with a cleft lip or cleft lip and cleft palate (CL±P) and impacts of treatments. DESIGN Cross-sectional, mixed methods study. SETTING Caregivers and health-care providers were recruited from 3 academic craniofacial centers and national advertisements. Most interviews were conducted by telephone, and surveys were completed online. PARTICIPANTS Caregivers had a child less than 3 years of age with CL±P and spoke either English or Spanish. Health-care providers were members of a cleft team. Caregivers (n = 492) and health-care professionals (n = 75) participated in at least one component of this study. MAIN OUTCOME MEASURE(S) Caregivers and health-care providers participated in tasks related to instrument development: concept elicitation for items within relevant health domains, prioritization of items, and item review. RESULTS We identified 295 observations of infant well-being across 9 health areas. Research staff and specialists evaluated items for clarity, specificity to CL±P, and responsiveness to treatment. Caregivers and health-care providers rated the resulting list of 104 observations and developed the final instrument of 65 items. CONCLUSIONS In this phase of development of the Infant with Clefts Observation Outcomes (iCOO) instrument, items were developed to collect caregiver observations about indicators of children's health and well-being across multiple domains allowing for psychometric testing, sensitivity to changes associated with treatment, and documentation of the effects of treatment.
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Affiliation(s)
- Carrie L Heike
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Meredith Albert
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Cassandra L Aspinall
- 7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Suzel Bautista
- 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Claudia Crilly Bellucci
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen A Kapp-Simon
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Janine Rosenberg
- 21725University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - Babette Siebold
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
| | - Laura P Stueckle
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
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Maternal and Paternal Well-Being During Nasoalveolar Molding and Primary Surgery Periods. J Craniofac Surg 2019; 30:2227-2232. [PMID: 31574786 DOI: 10.1097/scs.0000000000006028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The aim was to evaluate the anxiety and depression of both the father and mother of an infant with cleft lip and palate (CLP) before, during and after nasoalveolar molding (NAM) therapy and before and after the lip surgery. SUBJECTS AND METHOD Forty mothers (age range: 18-36; mean ± SD: 23.6 ± 4.51) and 40 fathers (age range: 19-40; mean ± SD: 26.9 ± 4.69) of infants with CLP were asked to answer the 21-item Beck Depression as well as Anxiety Inventory (BDI and BAI) at 1 week after birth and before any intervention (T1), after impression taking (T2), after 2 months of NAM (T3), immediate before primary surgery (T4) and approximately 1 month of recovery after surgery (T5). RESULTS Maternal and paternal depression levels between T1, T2, T3, T4, and T5 showed significant differences (P < 0.05). The BDI scores decrease from T2 to T3 and T4 to T5. The increases of scores from T3 to T4 were significant (P < 0.05). The maternal depression and anxiety levels were higher than the paternal ones in all time periods. The BDI and BAI levels were lesser in mothers and fathers of babies with unilateral than bilateral CLP (P < 0.05). CONCLUSION Hence realizing of recovery, being in contact with the cleft team and other families, and having an active role in the therapy, the maternal and parental well-being increase with NAM therapy. However, depression and anxiety levels significantly increase before the lip surgery. It may be recommended that the cleft team deliver information and psychological support especially at birth and before the surgical approaches.
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