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Nasoalveolar Molding Improves Appearance of Children with Bilateral Cleft Lip–Cleft Palate

Lee, Catherine T. H. B.D.S.; Garfinkle, Judah S. D.M.D., M.S.; Warren, Stephen M. M.D.; Brecht, Lawrence E. D.D.S.; Cutting, Court B. M.D.; Grayson, Barry H. D.D.S.

Plastic and Reconstructive Surgery: October 2008 - Volume 122 - Issue 4 - p 1131-1137
doi: 10.1097/PRS.0b013e318184590c
PEDIATRIC/CRANIOFACIAL: ORIGINAL ARTICLES
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Background: Bilateral cleft lip–cleft palate is associated with nasal deformities typified by a short columella. The authors compared nasal outcomes of cleft patients treated with banked fork flaps to those of patients who underwent nasoalveolar molding and primary retrograde nasal reconstruction.

Methods: A retrospective review of 26 consecutive patients with bilateral cleft lip–cleft palate was performed. Group 1 patients (n = 13) had a cleft lip repair and nasal correction with banked fork flaps. Group 2 patients (n = 13) had nonsurgical columellar elongation with nasoalveolar molding followed by cleft lip closure and primary retrograde nasal correction. Group 3 patients (n = 13) were age-matched controls. Columellar length was measured at presentation and at 3 years of age. The number of nasal operations was recorded to 9 years. The Kruskal-Wallis and Tukey-Kramer tests were used for statistical analysis.

Results: Initial columellar length was 0.49 ± 0.37 mm in group 1 and 0.42 ± 0.62 mm in group 2. Post–nasoalveolar molding columellar length was 4.5 ± 0.76 mm in group 2. By 3 years of age, columellar length was 3.03 ± 1.47 mm in group 1, 5.98 ± 1.09 mm in group 2, and 6.35 ± 0.99 mm in group 3. Group 2 columellar length was significantly greater (p < 0.001) than that of group 1 and not statistically different from that of group 3 (p > 0.05). All group 1 patients (13 of 13) needed secondary nasal surgery. No nasoalveolar molding patients (zero of 13, group 2) required secondary nasal surgery.

Conclusion: Nonsurgical columellar elongation with nasoalveolar molding followed by primary retrograde nasal reconstruction restored columellar length to normal by 3 years and significantly reduced the need for secondary nasal surgery.

New York, N.Y.

From the Institute of Reconstructive Plastic Surgery, New York University School of Medicine.

Received for publication July 30, 2007; accepted February 15, 2008.

Disclosure:The authors hereby certify that, to the best of their knowledge, no financial support or benefits have been received by any coauthor, by any member of their immediate families, or by any individual or entity with whom or with which they have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported on in this article.

Barry H. Grayson, D.D.S., New York University Medical Center, Institute of Reconstructive Plastic Surgery, 560 First Avenue, TCH-169, New York, N.Y. 10022, barry.grayson@nyumc.org

©2008American Society of Plastic Surgeons