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The Anatomic Changes Achieved with Presurgical Nasoalveolar Molding in Unilateral Cleft Lip and Palate: A Meta-Analysis
Zachary LeBlanc
*, Maya Abul-Khoudoud, Mary Elizabeth Katinas, Jill Schechter, Thomas A. Imahiyerobo, Naikhoba Munabi
Department of Surgery, Columbia University Medical Center, New York, NY
BACKGROUND: Nasoalveolar molding (NAM) is a presurgical infant orthopedic technique (PSIO) used to improve proportions in patients with cleft lip/palate prior to primary repair. NAM is effective but difficult to implement due to high costs and burden of care. Newer PSIO techniques offer lower cost, easier use, and better patient tolerance but lack robust evidence. This study evaluates objective changes in nasal and alveolar proportions achieved with NAM as a baseline for comparison with new techniques.
METHODS: A search of PubMed and Cochrane databases was performed for studies published before Nov 2024. Included studies reported quantitative measurements in non-syndromic patients with unilateral cleft lip/palate treated before 2 months of age. Data extracted included treatment variables and pre-/post-NAM measurements.
RESULTS: 11 RCTs, 1 non-RCT, 1 prospective cohort study, and 11 case series/reports (n=303 patients) met inclusion criteria. NAM was initiated at 14.7±9.9 days. Treatment ranged from 6 weeks to 5 months. 79.95% of protocols required weekly adjustments. Alveolar cleft decreased from 12.12±3.31 mm to 3.52±2.14 mm (n=283,p<0.001). NAM increased columella angle from 37.69±9.27° to 69.56±10.89° (n=111,p<0.001) and nasal dome height from 9.10 mm±1.86 mm to 13.68 ±2.10 mm (n=81,p<0.001). Nostril width decreased from 14.47±1.91 mm to 10.83±2.05 mm on the cleft side (n=122,p<0.001) without significant change to the non-cleft side (5.42±1.18 mm to 5.47±1.24 mm,p=0.052). Nostril height increased from 1.98±0.96 mm to 5.92±1.01 mm on the cleft side (n=121,p<0.001) and from 4.58±0.97 mm to 5.59±1.08 mm on the non-cleft side (p<0.001).
CONCLUSIONS: NAM reduced cleft width by 71%, straightened the columella by 31.8°, and improved cleft nostril width-to-height ratio from 7.3 to 1.8. Interpretation of these changes is limited by variability in measurement techniques, protocol duration, and patient numbers. This study provides objective data on NAM outcomes to help manage family expectations, optimize surgical planning, and serve as a comparison for novel techniques.
Figure 1: Nostril dimensions before and after NAM. Nostril width and height measurements from each study depicted by shaded ellipse. Weighted average of nostril width and height represented by darker ellipse.
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