Three-dimensional longitudinal assessment of nasal development with and without Nasoalveolar molding therapy in cleft lip and palate patients.

BACKGROUND

Grayson-type presurgical nasoalveolar molding (PNAM) is an established method in presurgical infant orthopedics. This study compared PNAM therapy with conventional palatal plates across cleft types, focusing on nasal morphology.

METHODS

Seventy-two patients with non-syndromic unilateral (UCLP) and bilateral cleft lip and palate (BCLP) were followed from birth to two years. Three-dimensional (3D) models of the perinasal area were obtained via cast-based scans or 3D photographs; right-sided UCLP cases were mirrored to the left. Two independent reviewers analyzed anatomical landmarks with excellent inter-rater reliability (ICC = 0.88). Initial and two-year measurements were compared between PNAM (NAM group) and conventional treatment (non-NAM group).

RESULTS

Of the 72 patients, 46 had UCLP and 26 BCLP. In BCLP, NAM therapy promoted greater columella elongation from 2.1 mm at T0 to 5.2 mm at T3 compared to a change from 2.4 mm to 3.5 mm in the non-NAM group (p = 0.300). In UCLP, NAM was also associated with increases in columella (p = 0.387) and improved columella deviation angles, from a median of 48.1° at T0 to 85.6° at T3, while non-NAM showed a modest increase from 70.6° to 79.1°, (p = 0.167) Significant reductions were observed cleft-side nostril length (p = 0.027) and width (p = 0.029).

CONCLUSION

This study, using 3D imaging, demonstrates the clinically relevant capability of PNAM to improve nasal morphology compared to conventional treatment, potentially enhancing primary cheiloplasty outcomes. The longitudinal design three-dimensionally tracks preoperative and postoperative changes over two years, with further investigation needed for long-term stability.