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Comparison of post-surgical soft tissue changes between bilateral cleft patients treated with and without a modified
Ramzi Haddad1, Maria Saadeh2, Pamela Genno3
1Department of Otolaryngology-Head and Neck Surgery, Division of Orthodontics and Dentofacial Orthopedics, American University of Beirut, Medical Center, Beirut, Lebanon; Department of Orthodontics and Dentofacial Orthopedics, Montpellier University, Montpellier, France.
Introduction:
The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced.
Aims:
This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to a control group where no NAM was used.
Material And Methods:
At a tertiary care paediatric hospital, a historical cohort group of complete BCLP patients (n=15) was compared to a prospectively collected group of complete BCLP patients who underwent NAM therapy (n=15). In the NAM group (mean age: 1.1mos±0.2), a new modification of the NAM appliance was implemented. In the control group (mean age: 5mos±0.2), no NAM treatment was adopted prior to lip closure surgery. Soft tissue nasolabial segments were measured on initial (T1), post-NAM (T2) and 3 months post-surgery (T3) photographs; measurements were analysed statistically.
Results:
In the NAM group, cleft size was reduced by 68 to 70% in 4-5months and all measurements improved between T1 and T2. Columellar crest inclination decreased by 74%, columellar length increased by 184%, nostril and bialar widths decreased by 36% and 16%, respectively. The lip philtrum was elongated by 49.5%. At T3, all soft tissue variables statistically improved better in NAM versus non-NAM groups.
Conclusion:
The modified NAM appliance provided improved results of lip approximation and nasal measurements compared to non-NAM treatment.
