A Comparative Evaluation of Efficacy and Efficiency of Grayson's Presurgical Nasoalveolar Molding Technique in Patients with Complete Unilateral Cleft Lip and Palate with Those Treated with Figueroa's Modified Technique

Changes in nasal symmetry after presurgical nasoalveolar molding in infants treated with complete unilateral cleft lip and palate: A follow-up study

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.

Comparative clinical evaluation of modified and conventional Grayson's presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate

BACKGROUND

Presurgical nasoalveolar molding (PNAM) was introduced by Grayson et al., in 1993 to presurgically mold the alveolus, lip, and nose in infants with cleft lip and palate (CLP). The aim of this comparative clinical trial was to evaluate the efficacy and efficiency of Modified and Conventional Grayson's PNAM in patients concerning morphological and anatomical changes in maxillary alveolus, nasal symmetry, number of visits, and duration of treatment.

MATERIALS AND METHODS

In this comparative clinical trial study, 16 infants with unilateral complete CLP were equally divided into two groups: Group I (modified PNAM technique using titanium molybdenum alloy [TMA] wire nasal stent) and Group II (conventional PNAM technique using stainless steel wire nasal stent). Patient photographic evaluation of nasal symmetry and maxillary study model CAD-CAM analysis, pre- and post-operatively in both groups, were compared using a paired t-test between the groups using the Chi-square test with P < 0.05 as statistically significant.

RESULTS

In both groups, on evaluating nasal measurements, statistically significant (P < 0.05) decrease in nasal width and increase in columella deviation angle, a decrease of nostril length, and an increase of columella length in Group I were observed. On maxillary study model evaluation, a statistically significant (P < 0.05) decrease in width of the alveolar cleft was noticed in both groups and lateral deviation of the incisal point in Group I and width of the palatal cleft in Group II was noticed.

CONCLUSION

This study showed a morphological improvement in nasal symmetry and maxillary alveolar morphology in complete unilateral CLP patients, treated with both Modified and Conventional PNAM techniques, with the Modified PNAM technique being more efficient for treatment duration and the number of adjustments as there are less number of visits.

Short-Term Efficacy of Presurgical Vacuum Formed Nasoalveolar Molding Aligners on Nose, Lip, and Maxillary Arch Morphology in Infants With Unilateral Cleft Lip and Palate: A Prospective Clinical Trial

OBJECTIVES

The purpose of this study was to evaluate the short-term effect of series of preadjusted vacuum formed nasoalveolar molding VF NAM aligners on the morphology of nose, lip, and maxillary arch in infants with unilateral cleft lip and palate (UCLP).

DESIGN

Prospective clinical trial.

SETTING

Unilateral cleft lip and palate patients referred to outpatients' clinic.

PATIENTS

Sixteen nonsyndromic infants with UCLP, less than 2 months of age were included from April 2017 to April 2018.

INTERVENTIONS

All infants received VF NAM therapy. Standardized digital frontal and basilar photographs and 3D digital models were taken before initiation of VF NAM therapy (T1) and after completion of VF NAM therapy (T2).

MAIN OUTCOME MEASURE(S)

Changes in morphology of the nose, lip, and maxillary arch.

RESULTS

Statistical analysis comparing T1 and T2 measurements was performed. Frontal and basilar photographic analysis showed a statistically significant reduction of columella displacement, interlabial gap distance, and nostril width at cleft side (CS), while the nasal height, nostril height at CS, nostril width at noncleft side (NCS), columella deviation angle, nasal tip protrusion, and nostril area at both CS and NCS increased significantly with VF NAM therapy. The nasal width, nostril height at NCS showed no significant change after presurgical VF NAM aligners therapy. The analysis of digital models demonstrated a statistically significant reduction of alveolar cleft width, anterior arch width, arch length, midline deviation, and palatal cleft width, while the posterior arch width and arch perimeter increased significantly with VF NAM therapy.

CONCLUSION

Vacuum formed NAM therapy was effective in reducing the nasoalveolar deformities associated with infants with UCLP and improved the alveolar morphology and nasal symmetry.