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Mid-Term Impact of Nasoalveolar Molding on Secondary Surgical Procedures in Cleft Patients: A Retrospective Cohort
Lucas M Ritschl1, Katharina Pippich1, Hannes Singer1
1Department of Oral and Maxillofacial Surgery, University Hospital TUM Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich.
Background:
Nasoalveolar molding (NAM) is an established form of presurgical infant orthopedics (PSIO). However, evidence on its medium- and long-term effects remains limited due to the few long-term studies. This study analyzes the medium-term impact of NAM, with a particular focus on the need for secondary or corrective surgeries following NAM or non-NAM treatment protocols.
Materials And Methods:
A retrospective cohort study was conducted of patients with cleft lip and palate (CLP) and cleft lip and alveolus (CLA) who received primary cheiloplasty between January 2012 and December 2021. All secondary or corrective surgeries following the same treatment protocol from PSIO through the end of 2024 were documented, including lip corrections, nostril corrections, oronasal fistula closure, and velopharyngoplasty. A univariable regression analysis was performed to assess the association between NAM therapy and the occurrence and number of secondary procedures.
Results:
A total of 140 patient records were analyzed, comprising 53 females and 87 males. Of these, 104 patients were diagnosed with CLP and 36 with CLA. NAM treatment was administered to 97 patients (69%). The most common secondary procedures were lip correction (42%) and closure of oronasal fistula (19%), followed by nostril correction (12%) and velopharyngoplasty (6%). However, no significant associations were found between NAM treatment and necessity, frequency, or kind of secondary surgical interventions.
Conclusions:
This study provides initial insights into the medium-term effects of NAM therapy and its effect on early secondary surgeries. Although NAM was predominantly applied in more severe CLP and CLA cases, there was no increased need for secondary or corrective surgeries compared with the control group.
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Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...