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Comparative Effectiveness Of Primary Nasal Surgery With And Without Nasoalveolar Molding On Long-term Secondary Nasal Surgery
Stephen M. Warren, MD, Mohammad M. Ahmed, DDS, Parit Patel, MD, Lawrence E. Brecht, DDS, Barry H. Grayson, DDS, Court B. Cutting, MD.
NYU Langone Medical Center, New York, NY, USA.

Purpose: Nasoalveolar molding (NAM) was developed to improve dentoalveolar, septal, and lower lateral cartilage position prior to cleft lip repair. The purpose of this study was to compare the efficacy of primary nasal surgery performed with and without presurgical NAM on long-term unilateral and bilateral complete cleft nasal results.
Methods: A retrospective review of 275 complete unilateral or bilateral cleft lip and palate (CLP) patients from 1990-2005 was conducted. Two-hundred and forty-three patients (172 unilateral and 71 bilateral) were treated with NAM prior to surgical correction, and 32 patients (27 unilateral and 5 bilateral) were treated by surgery alone. The age at the time of follow up was between 5 and 14 years (average = 9.3 + 1.4 years). Nasal anthropometric distances and angular relationships were measured and the rate of secondary nasal revisions was compared.
Results: All measurements demonstrated a greater degree of nasal symmetry in NAM-treated patients compared to surgery alone. Of the 171 patients with unilateral CLP who were treated with NAM and primary nasal reconstruction, 5 patients (3%; p<0.05) underwent a single early secondary revision. Similarly, out of 71 patients with bilateral CLP, 5 (7%; p<0.05) underwent a single early secondary revision. The average age at revision for these 10 patients was 5 years, 6 months. In the primary nasal reconstruction without NAM group, 6 of the 28 patients with unilateral cleft lip and palate underwent an early nasal revision (21%), and to 2 out of 5 patients with bilateral CLP (40%) underwent an early nasal revision.
Conclusions: The data demonstrate that the lower lateral are more symmetric in the NAM-treated patients compared to the surgery alone patients. Furthermore, the improved symmetry observed in NAM-treated noses during the time of the primary surgery is maintained at least to nine years of age.


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