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Caregiver-Reported Burden and Satisfaction of Presurgical Lip, Alveolus and Nose Approximation (PLANA) Therapy Compared to Nasoalveolar Molding (NAM)
Paige E. Warner¹, Bria Etienne², Theresa K. Webster^*3, Thomas A. Imahiyerobo³, Jill Schechter², Naikhoba Munabi^3
1Columbia University Vagelos College of Physicians and Surgeons, New York, NY; ²Department of Dental Medicine, Columbia University Irving Medical Center, New York, NY; ³Plastic and Reconstructive Surgery, New York Presbyterian - Columbia/Cornell, New York, NY

Background. Nasoalveolar molding (NAM) is a presurgical infant orthopedic (PSIO) technique that facilitates cleft lip ± palate (CL/P) repair by improving nasolabial and alveolar morphology before surgery. However, NAM requires 12-16 visits over 3-5 months and is often poorly tolerated. Presurgical Lip, Alveolus and Nose Approximation (PLANA) is a newer PSIO technique using sequential nasal stents with only 4-5 visits and simpler at-home care. This pilot study evaluates caregiver burden and satisfaction of care with PLANA compared to NAM. Methods. This single-center study included parents of patients with CL/P who underwent PLANA or NAM between January 2017 and March 2026. Participants completed a 23-question survey, based on a published NAM questionnaire, assessing their PLANA or NAM experience (Dean et al. 2018). Responses were compared descriptively between groups and reported as total counts with percentages. Results. 23 primary caregivers of patients who underwent either PLANA (n = 17, 50% complete cleft) or NAM therapy (n = 11, 100% complete cleft) were included. 100% of PLANA and 90.9% of NAM patients completed therapy. Most caregivers in both groups traveled <30 miles to the treatment center (64.7% PLANA, 54.6% NAM). More PLANA patients had Medicaid (47.1% PLANA, 27.3% NAM) though more PLANA than NAM was covered by insurance (94.1% vs. 90.9%, respectively). PLANA parents reported less feeding difficulties (23.5% PLANA, 72.8% NAM) but more skin irritation (88.3% PLANA, 63.7% NAM). More PLANA caregivers noted moderate or significant change in their child's face (88.3% PLANA, 70.0% NAM). In the PLANA group, 94.1% of caregivers reported being "satisfied" or "very satisfied" with PSIO compared to 81.8% of NAM caregivers and one "very dissatisfied" NAM caregiver. Conclusion. PLANA caregivers were highly satisfied with their child's treatment, with fewer visits and less feeding difficulty but more skin irritation than NAM. Ongoing surveys will strengthen findings and clarify burden of cost, time-efficiency, and parental perspectives on PLANA-related outcomes.
Social Factors, PSIO-Related Complications, and Overall Caregiver Satisfaction with Outcomes

Survey Question	Response	NAM (n = 11)	PLANA (n = 17)
Travel and Insurance Factors
Distance to treatment center (miles)	<10 miles	2 (18.2%)	4 (23.5%)
	10-30 miles	4 (36.4%)	7 (41.2%)
	31-60 miles	3 (27.3%)	2 (11.8%)
	>60 miles	2 (18.2%)	3 (17.6%)
Travel time to treatment center (min)	<30 min	2 (18.2%)	4 (23.5%)
	30 - 59 min	4 (36.4%)	7 (41.2%)
	60 - 119 min	3 (27.3%)	5 (29.4%)
	≥120 min	2 (18.2%)	1 (5.9%)
Insurance type	Private insurance	8 (72.7%)	9 (52.9%)
	Public insurance/Medicaid	3 (27.3%)	8 (47.1%)
PSIO covered by insurance	No	1 (9.1%)	0 (0.0%)
	Yes	10 (90.9%)	16 (94.1%)
Complications
Skin Irritation	Mild/Moderate	7 (63.7%)	13 (76.5%)
	Severe	0 (0.0%)	2 (11.8%)
Feeding Difficulty	Mild/Moderate	7 (63.7%)	4 (23.5%)
	Severe	1 (9.1%)	0 (0.0%)
Caregiver-Reported Outcomes
Successful PSIO completion	Yes	10 (90.9%)	17 (100.0%)
	No	1 (9.1%)	0 (0.0%)
Parental rating of degree of face change after PSIO therapy	No change	2 (20.0%)	1 (5.9%)
	Slight change	1 (10.0%)	1 (5.9%)
	Moderate/Significant change	7 (70.0%)	15 (88.3%)
Satisfaction with PSIO therapy	Very dissatisfied	1 (9.1%)	0 (0.0%)
	Dissatisfied	0 (0.0%)	0 (0.0%)
	Neither satisfied nor dissatisfied	1 (9.1%)	1 (5.9%)
	Satisfied but outcome could be better	0 (0.0%)	1 (5.9%)
	Very satisfied	9 (81.8%)	15 (88.2%)

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