Nasoalveolar Molding Reduces Need for Cleft Lip Surgery

Researchers at the Loyola University Health System (Chicago, IL, ISA) conducted a retrospective cohort study of 276 patients with complete unilateral and bilateral cleft lip and palate (U/BCLP) to compare the risk of early secondary nasal revision surgery following NAM and surgery – which consisted of cleft lip repair and primary surgical nasal reconstruction – versus surgery alone. The NAM treatment group consisted of 172 patients with UCLP and 71 patients with BCLP, whereas the non-NAM-prepared group consisted of 28 patients with UCLP and 5 with BCLP.

The results showed that the risk of secondary nasal revision for patients with UCLP was 3% in the NAM group and 21% in the non-NAM group. The risk of secondary nasal revision for patients with BCLP was 7% in the NAM group compared with 40% in the non-NAM group. Using multicenter averages, the researchers found that overall non-NAM revision rates were 37.8% for UCLP and 48.5% for BCLP. The study was published in the June 2016 issue of The Journal of Craniofacial Surgery.

“NAM is a technique that molds the patient's lip, nose and gums, decreasing the width of the cleft and contouring the nose before surgery is performed. This makes the surgery easier to perform and now has been shown to improve outcomes and reduce cost,” said lead author plastic and reconstructive surgeon Parit Patel, MD. “Surgery always has a certain element of risk and the use of NAM reduces complications and the overall number of surgeries. This results in a potentially healthier child, which is really the ultimate goal.”

Cleft lip and palate are two of the most common major birth defects, resulting from incomplete closure of tissues of the face during development; the cause is unknown in most cases. NAM is based on an oral plate similar to a dental retainer that is typically implanted in a baby's mouth four to five weeks after delivery, helping to correct the deformity by reducing the size of the cleft before surgery is performed.

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