A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding
Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven.
Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments.
Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up.
Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.
04 August 2020 (online)
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- 1 Tang PM, Chao NS, Leung MW, Kelvin KW. Changes in nasal configuration following primary rhinoplasty: Direct anthropometric measurement in patients with complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2016; 53 (05) 557-561
- 2 Chang CS, Por YC, Liou EJ, Chang CJ, Chen PK, Noordhoff MS. Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: a single surgeon’s experience. Plast Reconstr Surg 2010; 126 (04) 1276-1284
- 3 Hosseinian B, Rubin MS, Clouston SAP. et al. Comparative analysis of three-dimensional nasal shape of casts from patients with unilateral cleft lip and palate treated at two institutions following rotation advancement only (Iowa) or nasoalveolar molding and rotation advancement in conjunction with primary rhinoplasty (New York). Cleft Palate Craniofac J 2018; 55 (10) 1350-1357
- 4 Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair: a 33-year experience. J Craniofac Surg 2003; 14 (04) 549-558
- 5 Lu TC, See UC, Chen PKT, Noordhoff MS. Unilateral Complete Cleft Lip Repair with Primary Semi-open Rhinoplasty. In: Anh Tran T, Panthaki Z, Hoballah J, Thaller S, eds. Operative Dictations in Plastic and Reconstructive Surgery. Springer, Cham; 2017
- 6 Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999; 36 (06) 486-498
- 7 Grayson BH, Shetye PR. Presurgical nasoalveolar moulding treatment in cleft lip and palate patients. Indian J Plast Surg 2009; 42 (01) (Suppl) S56-S61
- 8 Lee CT, Garfinkle JS, Warren SM, Brecht LE, Cutting CB, Grayson BH. Nasoalveolar molding improves appearance of children with bilateral cleft lip-cleft palate. Plast Reconstr Surg 2008; 122 (04) 1131-1137
- 9 Liou EJ, Subramanian M, Chen PK. Progressive changes of columella length and nasal growth after nasoalveolar molding in bilateral cleft patients: a 3-year follow-up study. Plast Reconstr Surg 2007; 119 (02) 642-648
- 10 Meazzini MC, Rossetti G, Morabito A, Garattini G, Brusati R. Photometric evaluation of bilateral cleft lip and palate patients after primary columella lengthening. Cleft Palate Craniofac J 2010; 47 (01) 58-65
- 11 Nazarian Mobin SS, Karatsonyi A, Vidar EN. et al. Is presurgical nasoalveolar molding therapy more effective in unilateral or bilateral cleft lip-cleft palate patients?. Plast Reconstr Surg 2011; 127 (03) 1263-1269
- 12 Zuhaib M, Bonanthaya K, Parmar R, Shetty PN, Sharma P. Presurgical nasoalveolar moulding in unilateral cleft lip and palate. Indian J Plast Surg 2016; 49 (01) 42-52
- 13 Chen PK-T, Noordhoff MS, Liou EJW. Treatment of Complete Bilateral Cleft Lip-Nasal Deformity. Semin Plast Surg 2005; 19: 329-342
- 14 Matsuo K, Hirose T. Nonsurgical correction of cleft lip nasal deformity in the early neonate. Ann Acad Med Singapore 1988; 17 (03) 358-365
- 15 Sommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg 2003; 112 (06) 1542-1548
- 16 Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 2005; 42 (06) 658-663
- 17 Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg 2004; 114 (04) 858-864