The Effects of Presurgical Nasoalveolar Molding on the Midface Symmetry of Children with Unilateral Cleft Lip and Palate: A Long-term Follow-up Study

Background: Midface symmetry is an important indicator of success of complete unilateral cleft lip and palate (CUCLP) treatment. There is little literature on the long-term effects of presurgical nasoalveolar molding (PNAM) on midface symmetry in children treated for CUCLP. This study aimed to compare children with CUCLP who underwent PNAM before surgical interventions, children who did not receive PNAM, and age- and sex-matched controls in terms of midface symmetry. Methods: We evaluated 39 frontal facial photographs of 13 patients with CUCLP who underwent PNAM as part of the treatment (group 1: PNAM), 13 patient with CUCLP who did not undergo PNAM (group 2: no nasoalveolar molding), and 13 age- and sex-matched controls. The children were evaluated in their fifth year of life. Three midline and 3 bilateral orthopometric midface landmarks were programmed using a custom software (OnyxCeph3, Image Instruments GmbH, Germany), and corresponding linear measurements from the midline were obtained and compared between the groups using 1-way analysis of variance and Scheffe’s post hoc test. Results: Significant differences were observed between the control and CUCLP groups for the measurements of the proanasale, subnasale, and zygion. However, there were no significant differences between the PNAM and no nasoalveolar molding groups for the 6 midface landmarks. Conclusions: PNAM does not seem to significantly impact the long-term midface symmetry in children with CUCLP.

[1]  A. Swift,et al.  Cleft lip and palate: diagnosis and management. , 2015, British journal of hospital medicine.

[2]  P. Shetye.  Presurgical infant orthopedics. , 2012, The Journal of craniofacial surgery.

[3]  Aslıhan Uzel,et al.  Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review , 2011, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[4]  Amara Abreu,et al.  Complications and Solutions in Presurgical Nasoalveolar Molding Therapy , 2009, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[5]  J. Mulliken,et al.  Discussion , 2009 .

[6]  Ilker Ercan,et al.  Facial asymmetry in young healthy subjects evaluated by statistical shape analysis , 2008, Journal of anatomy.

[7]  C. Cutting,et al.  Nasoalveolar Molding Improves Appearance of Children with Bilateral Cleft Lip–Cleft Palate , 2008, Plastic and reconstructive surgery.

[8]  S. Bartlett.  Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children With Complete Unilateral Cleft Lip and Palate (Dutchcleft) , 2008 .

[9]  A. Kuijpers-Jagtman,et al.  Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft) , 2006, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[10]  J. Xia,et al.  Presurgical Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate: A Preliminary Study , 2006, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[11]  B. Cho.  Unilateral Complete Cleft Lip and Palate Repair Using Lip Adhesion Combined with a Passive Intraoral Alveolar Molding Appliance: Surgical Results and the Effect on the Maxillary Alveolar Arch , 2006, Plastic and reconstructive surgery.

[12]  M. Mommaerts,et al.  Standards for digital photography in cranio-maxillo-facial surgery - Part I: Basic views and guidelines. , 2006, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[13]  C. Cutting,et al.  Prepubertal Midface Growth in Unilateral Cleft Lip and Palate following Alveolar Molding and Gingivoperiosteoplasty , 2004, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[14]  Toni Rietveld,et al.  Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers with Cleft Lip and Palate , 2003, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[15]  A. Hemprich,et al.  Funktionelle und ästhetische Ergebnisse von Nasenkorrekturen bei Patienten mit Lippen-Kiefer-Gaumen-Spalten , 2003, Mund-, Kiefer- und Gesichtschirurgie.

[16]  A. Hemprich,et al.  [Functional and aesthetic outcome of nasal surgery in cleft lip palate patients]. , 2003, Mund-, Kiefer- und Gesichtschirurgie : MKG.

[17]  C. Cutting,et al.  Associations between Severity of Clefting and Maxillary Growth in Patients with Unilateral Cleft Lip and Palate Treated with Infant Orthopedics , 2001 .

[18]  C. Cutting,et al.  Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics. , 2001, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[19]  C. Cutting,et al.  Presurgical Nasoalveolar Orthopedic Molding in Primary Correction of the Nose, Lip, and Alveolus of Infants Born with Unilateral and Bilateral Clefts , 2001 .

[20]  C. Cutting,et al.  Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. , 2001, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[21]  K. Mishima,et al.  Comparison between Palatal Configurations in UCLP Infants with and without a Hotz Plate until Four Years of Age , 2000 .

[22]  K. Mishima,et al.  Comparison between palatal configurations in UCLP infants with and without a Hotz plate until four years of age. , 2000, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[23]  F. Bookstein,et al.  Long-Term Effects of Nasoalveolar Molding on Three-Dimensional Nasal Shape in Unilateral Clefts , 1999 .

[24]  F. Bookstein,et al.  Long-Term Effects of Nasoalveolar Molding on Three-Dimensional Nasal Shape in Unilateral Clefts , 1999, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[25]  A. Kuijpers-Jagtman,et al.  Short-term Cost-effectiveness Analysis of Presurgical Orthopedic Treatment in Children with Complete Unilateral Cleft Lip and Palate , 1998 .

[26]  A. Kuijpers-Jagtman,et al.  Short-term cost-effectiveness analysis of presurgical orthopedic treatment in children with complete unilateral cleft lip and palate. , 1998, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[27]  D. Hurwitz,et al.  Presurgical orthopedics in the surgical management of unilateral cleft lip and palate. , 1995, Plastic and reconstructive surgery.

[28]  C. Cutting,et al.  Preoperative columella lengthening in bilateral cleft lip and palate. , 1993, Plastic and reconstructive surgery.

[29]  J. Hoeksma,et al.  Effects of lip adhesion and presurgical orthopedics on facial growth: an evaluation of four treatment protocols. , 1992, Journal de biologie buccale.

[30]  K. Matsuo,et al.  Repair of Cleft Lip with Nonsurgical Correction of Nasal Deformity in the Early Neonatal Period , 1989, Plastic and reconstructive surgery.