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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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Arslan C, Aksahin EC, Nur Yılmaz RB, Germec Cakan D. Does YouTube TM Offer High-Quality Information About Nasoalveolar Molding? Cleft Palate Craniofac J 2024; 61:5-11. [PMID: 35861787 DOI: 10.1177/10556656221115025] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the content and quality of YouTubeTM videos concerning nasoalveolar molding (NAM). DESIGN YouTubeTM was searched for videos containing information relevant to NAM with the 2 keywords "nasoalveolar molding," and "presurgical infant orthopedics." A total of 24 out of 51 videos were found to be applicable to this study and rated for quality using the Global Quality Scale (GQS). To determine whether the contents of the selected 24 videos were useful or not, a content usefulness index consisting of 8 parameters was created. The videos were classified according to the usefulness index as low or high content videos. Spearman rank correlation analysis, Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U-tests were used for statistical analysis. RESULTS The mean GQS score of the 24 YouTubeTM videos on NAM was 2.3 ± 0.8, indicating overall poor quality. In terms of information, videos with high content (29.2%) were less in number than low content videos (70.8%). GQS values were found to be significantly higher in the high content group (P < .01). Regarding the source, video, and audio quality values were significantly higher in the expert group compared to the caregiver group (P < .01), whereas the usefulness index did not differ between groups (P > .05). A significant relationship was found between GQS and usefulness index, audio quality, and video quality (P < .001). CONCLUSIONS YouTube™ videos on NAM were generally inadequate in their content information and poor in quality. Expert videos, showing better audiovisual quality and flow compared to non-expert videos, did not offer higher quality information about NAM considering the usefulness index.
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Affiliation(s)
- Can Arslan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Elif Ceren Aksahin
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | | | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Okazaki T, Kawanabe H, Fukui K. Comparison of conventional impression making and intraoral scanning for the study of unilateral cleft lip and palate. Congenit Anom (Kyoto) 2023; 63:16-22. [PMID: 36371642 PMCID: PMC10098894 DOI: 10.1111/cga.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/14/2022] [Accepted: 09/21/2022] [Indexed: 11/15/2022]
Abstract
Patients with cleft lip and palate (CLP) encounter various problems, including disorders related to feeding, esthetics, and pronunciation. We compared two impression methods, conventional impression making and intraoral scanning, to study unilateral cleft lip and palate (UCLP). Patients with UCLP (n = 7) were selected, and palatal impressions were taken by two steps: (1) impressions were obtained using an addition silicone rubber impression material, and a plaster model was prepared and (2) optical impressions were obtained using a desktop three-dimensional (3D) scanner and stereolithography (STL). Data were generated by two impression system combinations through STL. The results were analyzed using the Kruskal-Wallis or Mann-Whitney U test. There were no significant differences in the dimensions of the models between both groups. The measured depth of the alveolar cleft defects was deeper in the plaster model group (STL) than in the intraoral scanner group (STL). Digital models may prevent the risk of aspiration and respiratory disorders by using impression materials for preoperative jaw treatment of newborns and infants. We compared the results of both impression methods in the same patient and found that a shift to the 3D printer model is a safe alternative for preoperative jaw correction, as evidenced from the amount of tissue displaced due to the pressure applied during impression taking. In the future, we would like to conduct clinical research with a larger sample size of CLP patients to further corroborate these findings.
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Affiliation(s)
- Tomoyo Okazaki
- Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, Ohu University School of Dentistry, Koriyama City, Fukushima, Japan
| | - Hitoshi Kawanabe
- Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, Ohu University School of Dentistry, Koriyama City, Fukushima, Japan
| | - Kazunori Fukui
- Division of Orthodontics and Dentofacial Orthopedics, Department of Oral Growth and Development, Ohu University School of Dentistry, Koriyama City, Fukushima, Japan
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Chaisooktaksin N, Chimruang J, Worasakwutiphong S, Tansalarak R. Three-dimensional Changes of Maxillary Alveolar Morphology After Using Modified Nasoalveolar Molding in Patients with Complete Unilateral Cleft lip and Palate. Cleft Palate Craniofac J 2022:10556656221086816. [PMID: 35285744 DOI: 10.1177/10556656221086816] [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: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the three-dimensional changes in maxillary alveolar morphology after using modified NAM in patients with complete unilateral cleft lip and palate. DESIGN This is a retrospective study. SETTING The study was carried out in the dental hospital, Faculty of Dentistry of Naresuan University, Phitsanulok, which serves as a tertiary care center. PATIENTS The population sample consisted of 19 patients with nonsyndromic complete unilateral cleft lip and palate. INTERVENTION All patients received the modified NAM treatment based on the treatment protocol of the Naresuan University Cleft and Craniofacial Center, Thailand. MAIN OUTCOME MEASURE Dental models obtained at pre-treatment (T0) and post-treatment (T1) were scanned to construct the digital models. The maxillary digital models that showed dimensional changes between T0 and T1 were measured using a computer graphic software. RESULTS The modified NAM resulted in a significant decrease in the anterior cleft width, posterior cleft width, and anterior arch width. Conversely, it caused a significant increase in the length of the lesser cleft segment and the greater segment rotation. However, the change in the height of both segments and posterior arch width was not found to be significant. CONCLUSIONS The modified NAM was an effective device for reducing the alveolar cleft width while improving the alignment of alveolar cleft segments.
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Affiliation(s)
- Nuntabhorn Chaisooktaksin
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand
| | - Jutharat Chimruang
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
| | - Saran Worasakwutiphong
- Department of Surgery, Faculty of Medicine, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
| | - Ratchawan Tansalarak
- Department of Preventive Dentistry, Faculty of Dentistry, 59212Naresuan University, Phitsanulok 65000, Thailand.,Naresuan University Cleft and Craniofacial Center, Phitsanulok 65000, Thailand
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Effect of Cleft Width on the Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate. J Craniofac Surg 2021; 33:426-431. [PMID: 34261960 DOI: 10.1097/scs.0000000000007975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.
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Palatal growth changes in newborns with unilateral and bilateral cleft lip and palate from birth until 12 months after early neonatal cheiloplasty using morphometric assessment. Clin Oral Investig 2021; 25:3809-3821. [PMID: 33409695 DOI: 10.1007/s00784-020-03711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life. MATERIALS AND METHODS Upper dental arches of 68 neonates with UCLP and BCLP were evaluated using 2D and 3D morphometry based on dental casts obtained in two age categories (T0 before early neonatal cheiloplasty-UCLP 4 ± 3 days, BCLP 6 ± 5 days; T1 before palatoplasty-UCLP 10 ± 2 months, BCLP 12 ± 3 months). RESULTS Intensive palatal growth was manifested in both directions of the palate. Palatal growth in the anterior direction was not restricted, despite the intercanine (CC´) and anterior (LL´) widths being significantly narrowed in the BCLP group (CC´ p = 0.019, LL´ p = 0.009). The posterior dental arches were significantly enlarged (UCLP p ≤ 0.001; BCLP p ≤ 0.001). The negative effect of cleft severity on palatal length was not confirmed (p = 0.802). Variability of the palate was immense mainly in BCLP infants (T0); however, it decreased in both cleft types, confirming the formative effect of palatal growth leading to alveolar cleft closure (UCLP p ≤ 0.001; BCLP p = 0.006 on the right, 0.005 on the left). CONCLUSIONS Both analyzed cleft groups (UCLP, BCLP) grew favorably during the first year of life, and the palatal growth was not limited in any direction. CLINICAL RELEVANCE Geometric morphometry allowed a comprehensive analysis of the palate, which can contribute to the improvement of surgical methods.
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