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Early Cleft Repair Versus Nasoalveolar Molding: Comparing Preoperative Severity and Postoperative Results Utilizing a Computer Engineered AI System

Goel, Pedram BS; Wolfswinkel, Erik Matthew MD; Fahradyan, Artur MD; Magee, William MD, DDS; Urata, Mark M. MD, DDS; Hammoudeh, Jeffrey A. MD, DDS

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 50-51
doi: 10.1097/01.GOX.0000584488.52230.7f
Craniofacial Abstracts
Open

Keck School of Medicine of USC, Los Angeles, CA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Early cleft lip repair (ECLR) can be performed safely and effectively. One persistent question is whether ECLR may be offered to wide unilateral complete clefts who historically would have received nasoalveolar molding (NAM). This study aims to compare the preoperative cleft severity of ECLR patients to those who underwent NAM pretreatment and compare postoperative outcomes.

METHODS: Unilateral CL patients (January 1, 2005, to September 11, 2018) were retrospectively reviewed and divided into 2 groups: ECLR (age <3 months) and presurgical NAM with CL repair (age 3–6 months). Pretreatment CL severity was assessed using an AI computer engineered system that calculated cleft width ratios (CWRs, pretreatment cleft width divided by commissure width). For further analysis, a second subset of wide complete cleft lip patients undergoing ECLR (excluding incomplete clefts) was created to compare to the NAM group.

RESULTS: Seventy-four ECLR patients and 25 NAM patients (average age at repair 32.24 and 117.56 days, respectively) met inclusion criteria. Mean CWR was 0.456 for ECLR patients and 0.501 for NAM patients (P = 0.165). The ECLR subgroup considering only patients with complete cleft lips had a mean CWR of 0.520, suggesting that this group had more severe clefts. The ECLR subgroup’s average lip length, frontal nasal breadth, commissure length, nostril breadth, nostril width, and nasal angle symmetry ratios were compared to the NAM group’s postoperatively. The average lip length, frontal nasal breadth, and commissure length symmetry ratios for the ECLR subgroup of 27 complete clefts were 0.88, 1.05, and 0.92, respectively, compared to 0.93, 1.08, and 0.89 for the NAM group (P = 0.181, P = 0.526, P = 0.378). The average nostril breadth, nostril width, and nasal angle ratios among the ECLR subgroup were 1.09, 1.17, and 1.12, respectively, compared to 1.12, 1.19, and 1.14 in the NAM group (P = 0.480, P = 0.613, P = 0.640).

CONCLUSION: ECLR provides patients with severe cleft lips an alternative option to NAM with at least equivalent results. With increased experience, long-term data, and increased awareness, we feel that ECLR has the potential to be a paradigm shift in the treatment of the cleft lip/nasal deformity.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.