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American Association of Plastic Surgeons

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The Nasoalveolar Molding Cleft Protocol: Long-term Results From Birth To Facial Maturity
Lauren M. Yarholar, MD, Chen Shen, BS, Court B. Cutting, MD, Barry H. Grayson, MD, David A. Staffenberg, MD, Eduardo D. Rodriguez, MD, DDS, Pradip R. Shetye, MD, Roberto L. Flores, MD.
New York University Langone Health, New York, NY, USA.

Purpose:
We present the first long-term outcomes analysis of the NasoAlveolar Molding (NAM) treatment protocol on patients with a cleft followed from birth to facial maturity.
Methods/Description:
Single institution retrospective review of all patients with a cleft who underwent NAM between 1990-2000. Collected data includes surgical and orthodontic outcomes of cleft care, GPP, alveolar bone grafting (ABG), speech surgery for velopharyngeal insufficiency (VPI), palatal fistula repairs, orthognathic surgery (OGS), and revision surgery to the nose and/or lip.
Results:
135 patients met the inclusion criteria [unilateral (UNI) 89, bilateral (BI) 46]. 84% (113/135) underwent GPP [UNI 78% (69/89); BI 96% (44/46)], 43% (58/135) underwent ABG [UNI 40% (36/89); BI 48% (22/46)], 18% (24/135) underwent speech surgery for VPI [UNI 14% (12/89); BI 26% (12/46)], 31% (42/135) underwent OGS [UNI 22% (20/89); BI 48% (22/46)], 11% (15/135) underwent revision surgery to lip and/or nose prior to facial maturity [UNI 9% (8/89); BI 15% (7/46)]. Of the patients that underwent GPP, 61% (69/113) did not require ABG [UNI 65% (45/69); BI 55% (24/44)] and 42% (48/113) required neither ABG nor OGS [UNI 51% (35/69); BI 30% (13/44)]. Mean follow-up was 18.8 years.
Conclusions
Clinical outcomes of the NAM treatment protocol from birth to facial maturity demonstrate a low rate of revision surgery to the lip and nose, as well as a low fistula and VPI rate. The reported frequency of orthognathic surgery is consistent with published data. In addition, 42% of patients who underwent NAM with GPP required neither ABG nor OGS.


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