An Early Comparative Analysis of Presurgical Lip, Alveolus, and Nose Approximation and Nasoalveolar Molding

This study evaluates the presurgical lip, alveolus, and nose approximation (PLANA) technique as a novel alternative to nasoalveolar molding (NAM). The study hypothesizes that PLANA can achieve comparable nasolabial outcomes to NAM while addressing its limitations, particularly by reducing the burden of care.

A retrospective review was conducted on 50 patients with nonsyndromic unilateral or bilateral cleft lip and palate (CLP) treated with either NAM ( n = 28, including 2 treatment discontinuations) or PLANA ( n = 22). The overall physical burden of care was assessed in the full cohort. A subset of 25 patients with complete unilateral cleft lip and palate (PLANA, n = 12; NAM, n = 13) was further analyzed to assess changes in nasolabial anthropometric ratios between the cleft and noncleft side using standardized two-dimensional photographs taken before and after treatment.

The physical burden of care was significantly lower in the PLANA group, with 61.2% fewer total office visits (5.2 versus 13.4; P < 0.001). The PLANA group also showed a 72.19% reduction in transient reversible side effects, such as oral, nasal, and cheek irritations (18.18% [ n = 4] versus 65.38% [ n = 17]; P < 0.001). PLANA achieved a significantly greater improvement in the columellar length ratio (0.53 versus 0.37; P = 0.026), whereas NAM demonstrated a greater increase in the nostril height ratio (0.29 versus 0.39; P = 0.04). No significant differences were observed in nostril width and alar base width ratios, or columellar deviation angle between the groups.

These findings suggest that PLANA significantly reduces the burden of care for patients with cleft lip and palate and may offer comparable nasolabial outcomes to NAM.