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30-year Outcomes And Revision Surgery Rates In A Large Cohort Of Patients Undergoing Nasoalveolar Molding Therapy
Natalie M. Plana, MD, Lucas R. Perez, BS, Rebecca Lisk, BS, David A. Staffenberg, MD, Pradip R. Shetye, DDS, Roberto L. Flores, MD.
NYU Langone Health, New York, NY, USA.
PURPOSE:This study aims to ascertain surgical revision rates in patients with a cleft who underwent nasoalveolar molding (NAM) and are followed to facial maturity.
METHODS:A single-institution retrospective review of all patients who underwent NAM from 1995-2005 was performed. Surgical interventions were categorized as primary (initial surgery), intermediate (revision prior to facial maturity) and mature (intervention after facial maturity). Patients with incomplete records through facial maturity were excluded. Pearson correlation coefficient and two-paired student t-tests were employed for data analysis.
RESULTS:81 patients were studied, 52(64%) with unilateral and 29(36%) with bilateral cleft lip. Primary surgery included lip repair (100%) rhinoplasty (100%), palatoplasty (94%) and alveolar bone graft (73%). Intermediate and mature rhinoplasty was performed in 4(5%) and 46(57%) of patients, respectively. Overall revision of any surgical type was performed at a rate of 16% including nasal revision after mature rhinoplasty [8(10%)], lip revision [36(44%)], and palate revision [9(11%)]. Average age at lip revision was 15.03 years, 10(12%) required a re-repair while 18(22%) underwent fat grafting alone. Primary and secondary repairs culminated in an average of 4.2 surgeries per patient. Patients with a bilateral cleft underwent a significantly greater number of total operations (4.62 v. 3.98,p=0.03) but no difference in revision rates to the lip (48% v. 60%,p=0.49), palate (17% v. 8%,p=0.25), or total (28% v. 23%,p=0.76). Nasal stenting significantly decreased likelihood of nasal revision surgery r(79)=-0.31,p<0.01.
CONCLUSION:Long-term follow-up demonstrates that patients with a cleft who receive NAM treatment can undergo a low surgical revision rate.
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