A Comparison of Presurgical Nasoalveolar Molding Therapy in the Treatment of Unilateral Versus Bilateral Cleft Lip and Palate
Sheila S. Nazarian Mobin, MD, Ashley Karatsonyi, Nick Vidar, Simon Gamer, DDS, John Groper, DDS, Mark M. Urata, MD, DDS.
Childrens Hospital, Los Angeles, Los Angeles, CA, USA.
A comparison of presurgical nasoalveolar molding therapy in the treatment of unilateral versus bilateral cleft lip and palate.
PURPOSE: To compare the outcome of presurgical nasoalveolar molding (PNAM) therapy in the treatment of patients with unilateral and bilateral cleft and palate (UCLP and BCLP, respectively).
METHODS: Sixteen patients with UCLP and thirteen patients with BCLP were treated from 2001 to 2005. The starting age for PNAM therapy was on average 39 days in UCLP and 45 days in BCLP and the average length of the therapy was 92 days in UCLP and 93 days in BCLP. Measurements of intraoral and extraoral casts were made, and statistical analyses were used to compare the differences between pre- and post-therapy measurements in UCLP patients as compared to BCLP patients. This is a retrospective study with blinded measurements.
RESULTS: Before PNAM therapy, UCLP patients had a starting intersegment alveolar cleft distance (ISD) that was larger than the average of the ISD’s in the BCLP patient (p=0.029) but smaller than the additive ISD of a BCLP patient (p=0.046). At baseline, UCLP patients displayed more asymmetry in the nostril width (NW) (p=0.005) and in the nasal angle (NA) (0.038). Interestingly, UCLP patients were more asymmetric before and after NAM. After PNAM therapy, there was a statistically significant decrease in both intersegment alveolar cleft distance for UCLP when compared to the average ISD of the BCLP patients (p=0.029), but when the ISDs of the BCLP patients were added together, a similar ISD improvement was seen in both types of patients. UCLP patients had a significantly larger decrease in the base alar width (BAW) when compared to BCLP patients (p=0.032). Furthermore, BCLP patients experienced a greater increase in columella height (CH) than UCLP patients (0.002). BCLP patients had a significant widening of the columella when compared to UCLP patients (p=0.002). The UCLP patients had significantly more obtuse angles on the affected cleft side than either affected side of the BCLP patients (p=0.005). There was no significant difference in intraoral alveolar width at the widest point (AW) between UCLP and BCLP patients either before or after PNAM. There was no significant difference between the sex, age, and length of the time the UCLP and BCLP patients utilized the appliance.
CONCLUSIONS: Presurgical nasoalvolar molding therapy has varying effects in unilateral and bilateral cleft lip and palate patients. Understanding these differences may help physicians and families better understand the benefits of PNAM in their child. When utilizing presurgical nasoalvolar molding, what may be achieved in unilateral cleft lip and palate patients differs from that in bilateral cleft lip and palate patients.