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• W4319161465 abstract "PURPOSE: Accredited cleft centers are increasingly utilizing nasoalveolar molding (NAM) amidst evidence suggesting favorable clinical outcomes in patients with unilateral cleft lip and palate. The impact of NAM on patients with bilateral cleft lip and palate (BCLP) at facial maturity remains largely unknown. We evaluate one of the largest reported cohorts of facially-mature patients with complete BCLP to evaluate the effects of NAM on clinical outcomes, including facial growth. METHOD: A single-institution retrospective study of non-syndromic patients with complete BCLP who underwent NAM between 1991-2000 was performed. The cleft protocol at our institution includes: NAM initiated within the first few weeks of life, cleft lip repair with primary rhinoplasty and gingivoperiosteoplasty (GPP) at 3-5 months of age, and cleft palate repair between 10-12 months of age. All study patients were followed from birth to facial maturity, with recorded variables including incidence of alveolar bone grafting (ABG), speech surgery, revisions to the lip and nose, fistula repair, and orthognathic surgery. Lateral cephalogram was performed at facial maturity prior to orthognathic surgery. Mann-Whitney U tests were used to evaluate comparative frequency of total cleft procedures and cephalometric parameters (SNA, position of maxilla; SNB, position of mandible; ANB, relationship between maxilla and mandible) with a previously published external cohort of patients with BCLP in which a minority (16.7%) underwent presurgical orthopedics prior to cleft lip repair without GPP (1). RESULTS: Twenty-four patients (16 male, 8 female) with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent ABG, and 9 (37.5%) required speech surgery. The average number of procedures per patient was 5.25 [standard deviation (SD) 1.70], compared to 8.47 (SD 1.78) in the published cohort (p<0.001). Average age at the time of lateral cephalogram was 18.64 (1.92) years. There was no significant difference between our cohort and the published cohort with respect to SNA [73.23 (5.32) degrees vs. 75.37 (6.40) degrees, p=0.346] or SNB [76.59 (5.03) degrees vs. 75.68 (6.14) degrees, p=0.448]. Average ANB was -3.34 (3.60) degrees compared to -0.32 (4.10) degrees (p=0.023). Twenty patients (83.3%) underwent orthognathic surgery. CONCLUSION: Patients with BCLP who underwent NAM and GPP can have significantly fewer total cleft procedures and comparable midface growth at facial maturity compared to patients who did not undergo this treatment protocol. REFERENCES: 1. David DJ, Smith I, Nugent M, Richards C, Anderson PJ. From Birth to Maturity: A Group of Patients Who Have Completed Their Protocol Management. Part III. Bilateral Cleft Lip-Cleft Palate. Plastic and Reconstructive Surgery. 2011;128(2):475-484." @default.
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• W4319161465 date "2022-10-01" @default.
• W4319161465 modified "2023-09-26" @default.
• W4319161465 title "Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding from Birth to Facial Maturity" @default.
• W4319161465 doi "https://doi.org/10.1097/01.gox.0000898528.50252.1e" @default.
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