Comparison of Two Nasoalveolar Molding Techniques in Complete Unilateral Cleft Lip Patient (NAM)

Two types of Presurgical Nasoalveolar Molding (NAM) coexist in Craniofacial Center in Chang Gung Memorial Hospital. The objective of this study is to compare the number of clinical visits, total prices, complications and nasal symmetry between these two NAM reconstruction methods.

Grayson's NAM reconstruction starts with alveolar molding first. The alveolar molding is made by gradual modification of the acrylic plate with periodic acrylic add on and grinding. After the alveolar cleft gap is less than 5 mm (usually at the end of second months), nasal molding was added to the alveolar molding plate. Figueroa's NAM reconstruction use labial tapes and acrylic relief to the palatal plate to approximate alveolar gap. The device starts with nasal and alveolar molding simultaneously.

Intervention: Grayson nasoalveolar molding This technique uses an acrylic plate to mold the alveolar segments and uses an extension to mold the alar cartilage of the nasal component. The construction is made by gradual modification of the acrylic plate with periodic acrylic add on and grinding. When the alveolar gap is reduced to 5 mm, nasal component are added to gradually mold the nasal cartilage and other nasal structures.

Intervention: Figueroa's nasoalveolar molding Figueroa technique uses labial tapes and acrylic relief to the palatal plate to approximate alveolar gap [3]. The nasal component is added in the beginning of the treatment to mold the nasal cartilage.

Nostril height: the vertical distance between horizontal reference lines to the highest point of nostril aperture.

Nostril height: the vertical distance between horizontal reference lines to the highest point of nostril aperture.

(T2) after nasoalveolar molding (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

Nostril height: the vertical distance between horizontal reference lines to the highest point of nostril aperture.

Nostril height: the vertical distance between horizontal reference lines to the highest point of nostril aperture.

Nostril width: The widest horizontal distance between the inner medial and lateral border of nostril aperture.

Nostril width: The widest horizontal distance between the inner medial and lateral border of nostril aperture.

(T2) after nasoalveolar molding (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

Nostril width: The widest horizontal distance between the inner medial and lateral border of nostril aperture.

Nostril width: The widest horizontal distance between the inner medial and lateral border of nostril aperture.

Nasal sill height: the vertical distance between the horizontal reference line to the lowest border of nostril aperture.

Nasal sill height: the vertical distance between the horizontal reference line to the lowest border of nostril aperture.

(T2) after nasoalveolar molding (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

From initial of nasoalveolar molding to finish of nasoalveolar molding (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

From the initial visit to the date of surgery (participants' surgery will be performed on 3-month of age)

From initial orthodontic visit to finish of NAM (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

From initial of NAM to finish of NAM (participants' nasoalveolar molding will be finished before surgery, an expected average of 3-months old)

Inclusion Criteria: Complete unilateral cleft lip infant Signed informed consent Exclusion Criteria: Incomplete unilateral cleft lip infant Association of other craniofacial anomalies

Chang CS, Wallace CG, Pai BC, Chiu YT, Hsieh YJ, Chen IJ, Liao YF, Liou EJ, Chen PK. Comparison of two nasoalveolar molding techniques in unilateral complete cleft lip patients: a randomized, prospective, single-blind trial to compare nasal outcomes. Plast Reconstr Surg. 2014 Aug;134(2):275-282. doi: 10.1097/PRS.0000000000000361.