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Nasoalveolar Molding Improves Long-Term Nasal Symmetry in Complete Unilateral Cleft Lip–Cleft Palate Patients

Barillas, Ingrid D.D.S.; Dec, Wojciech M.D.; Warren, Stephen M. M.D.; Cutting, Court B. M.D.; Grayson, Barry H. D.D.S.

Plastic and Reconstructive Surgery: March 2009 - Volume 123 - Issue 3 - p 1002-1006
doi: 10.1097/PRS.0b013e318199f46e
Pediatric/Craniofacial: Original Articles

Background: Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry.

Methods: A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip–cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry.

Results: All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated with surgery alone. Five symmetry measurements were significantly more symmetric in the nasoalveolar molding patients and one measurement demonstrated a nonsignificant but greater degree of symmetry compared with the patients treated with surgery alone.

Conclusions: The data demonstrate that the lower lateral and septal cartilages are more symmetric in the nasoalveolar molding patients compared with the surgery-alone patients. Furthermore, the improved symmetry observed in nasoalveolar molding–treated noses during the time of the primary surgery is maintained at 9 years of age.

New York, N.Y.

From the Institute of Reconstructive Plastic Surgery, New York University Medical Center.

Received for publication November 11, 2007; accepted August 18, 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 in this article.

Barry H. Grayson, D.D.S.; Institute of Reconstructive Plastic Surgery; New York University School of Medicine; 550 First Avenue, TCH-146; New York, N.Y. 10016;

©2009American Society of Plastic Surgeons