Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review

Abstract

Background: The purpose of this study was to evaluate the surgical outcome after using primary surgery to address bilateral cleft lip nose and palate deformities. In addition, the authors performed a systematic review to evaluate the effects of the nasoalveolar molding on non-syndromic bilateral cleft lip and palate.

Methods: A prospective cohort study on a surgeon's surgical outcome of 25 consecutively performed primary bilateral cleft lip nasal deformity repairs was conducted and a systematic review of the literature for studies published until December 2019 was done to evaluate the effect of presurgical NAM on nasolabial aesthetics and alveolar gap.

Results: Since 2014, 25 consecutive patients with complete bilateral cleft have undergone primary anatomical repair of the cleft nasal deformity using primary cheilorhinoplasty. The average columella length was 4.3 ± 1.3 mm. The average ratio of the columella height to nasal height was 0.48 mm 1 year postoperatively and 0.52 mm 5 years postoperatively. Statistically significant differences have been observed between the pre and postoperative alveolar and palatal gaps after using primary cheiloplasty or bilateral lip adhesion. After systematic literature searching, 14 identified studies were qualified for the final analysis, which included 433 patients. The overall study quality according to Oxford CEBM and GRADE scale was low.

Conclusions: The results of this study suggest that the proposed primary cheilorhinoplasty is a good alternative to improve nose appearance and alveolar gap in patients with primary bilateral cleft lip nose and palate deformity. Based on the available scientific evidence, definitive conclusions about the effectiveness of presurgical Naso Alveolar Molding on nasolabial aesthetics cannot be drawn. Quality of the included articles were too low to make a conclusion.

Fig. 1.

Standard anthropometric measurements. (x) Columellar height. (y) Alar base width. (z) Nasal height. (a) Pronasale. (b) Subnasale.

Fig. 2.

Alveolar gap measurement using Vernier caliper.

Fig. 3.

The V-Y-Z technique for complete bilateral cleft lip nose repair.

Fig. 4.

The V-Y-Z closure using transcutaneous stitches with bilateral medial V-Y plasty plus lateral Z plasty components.

Fig. 5.

Preoperative view of a 1-month-old patient with severe complete bilateral cleft lip and palate.

Fig. 6.

Postoperative view of the patient (3 months) shown in Figure 4 after undergoing lip adhesion first (1-month-old).

Fig. 7.

Postoperative view of the patient (1 year) shown in Figure 4 after undergoing primary rhinocheiloplasty using the proposed technique.

Fig. 8.

Preoperative view of a 1.5-month-old patient with severe complete bilateral cleft lip and palate.

Fig. 9.

Postoperative view of the patient (5 years) shown in Figure 7 after undergoing lip adhesion first (1 month-old) and nasal repair using the V-Y-Z technique and primary cheiloplasty (3 month-old).

Fig. 10.

Postoperative view of the maxillary arch form of the patient shown in Figure 7 (5 years old).

Fig. 11.

Preoperative view of a 3-month-old patient with complete bilateral cleft lip and palate.

Fig. 12.

Postoperative view of the patient (5 years) shown in Figure 10 after undergoing nasal repair using the V-Y-Z technique and primary cheiloplasty (3 months-old).

Fig. 13.

Postoperative view of the maxillary arch form of the patient shown in Figure 10 (5 years old).

Fig. 14.

Flowchart of literature search and selection.