title: Experience with presurgical nasal molding in infants with cleft lip and nose deformity.
abstract: BACKGROUND
  Nasal deformity in infants with nasolabial clefts persists if it is not actively corrected. Some surgeons repair the nose simultaneously with the lip. Nonsurgical nasal molding with mechanical support performed in the early neonatal period has proved to be an effective alternative to surgical correction.
  
  
  METHODS
  At the author's institution, for the past 4 years, infants with nasal asymmetry have been treated by presurgical nasal molding performed with a stent fixed to a conventional passive orthopedic plate. The efficiency of this method was evaluated retrospectively using photographs obtained at least 1 year after lip repair. Sixteen pairs of children were studied. One child of each pair had received the treatment with the stent, and the other one had been treated using the classic method of presurgical orthopedics with no stent; the diagnosis and remaining therapy were the same for both children. Nine maxillofacial surgeons and 22 students of dental medicine were asked to decide which nose of each pair was more symmetrical.
  
  
  RESULTS
  Seventy-five percent of students and 70 percent of surgeons found that the nasal stent nose was more symmetrical than its classically treated counterpart. Statistical analysis of the results revealed highly significant agreement between the two groups of evaluators.
  
  
  CONCLUSIONS
  Children who underwent presurgical treatment with a nasal stent had more symmetrical noses several years after lip repair than children treated by the classic method of preoperative orthopedics. Use of the modified appliance did not present major problems for the parents, but their cooperation is necessary. Treatment should start as soon as possible after birth, regardless of the width of the cleft.
authors: Ljubljana, Slovenia From the Department of Maxillofacial and Oral Surgery, University Medical Center Ljubljana.
authors: Vesna
authors: V
authors: Koželj
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D002971:Cleft Lip / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009666:Nose / Q000002:abnormalities* / Q000601:surgery*; D011300:Preoperative Care / Q000295:instrumentation* / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies
references: Salyer, K. E. Primary correction of the unilateral cleft lip nose: A 15-year experience. Plast. Reconstr. Surg. 77: 558, 1986.
references: McComb, H. Primary correction of unilateral cleft lip nasal deformity: A 10-year review. Plast. Reconstr. Surg. 75: 791, 1985.
references: McComb, H. K., and Coghlen, B. A. Primary repair of the unilateral cleft lip nose: Completion of a longitudinal study. Cleft Palate Craniofac. J. 33: 23, 1996.
references: Salyer, K. E. Unilateral cleft lip-nose repair: A 33-year experience. J. Craniofac. Surg. 14: 549, 2003.
references: Anderl, H. Primary unilateral cleft lip and nose reconstruction. In J. Bardach and H. Morris (Eds.), Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders, 1990. Pp. 184–196.
references: Singh, G. D., Moxham, B. J., Langley, M. S., et al. Changes in the composition of glycosaminoglycans during normal palatogenesis in the rat. Arch. Oral Biol. 39: 401, 1994.
references: Matsuo, K., Hirose, T., Otagiri, T., et al. Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period. Plast. Reconstr. Surg. 83: 25, 1989.
references: Matsuo, K., and Hirose, T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br. J. Plast. Surg. 44: 5, 1991.
references: Grayson, B., Cutting, C., and Wood, R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast. Reconstr. Surg. 92: 1422, 1993.
references: Grayson, B., Santiago, P. E., Brecht, L. E., et al. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac. J. 36: 486, 1999.
references: Maull, D. J., Grayson, B., Cutting, C. B., et al. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac. J. 36: 391, 1999.
references: Grayson, B. H., and Cutting, C. B. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac. J. 38: 193, 2001.
references: Singh, G. D., Levy-Berkowski, D., and Santiago, P. E. Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: Geometric morphometrics. Cleft Palate Craniofac. Surg. J. 42: 404, 2005.
references: Bennun, R. D., Perandones, C., Sepliarsky, V. A., et al. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: A 6-year follow-up. Plast. Reconstr. Surg. 104: 616, 1999.
references: Liou, E. J. W., Subramanian, M., Chen, P., et al. The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study. Plast. Reconstr. Surg. 114: 858, 2004.
references: Pai, B. C. J., Ko, E. W. C., Huang, C. S., et al. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac. J. 42: 658, 2005.
references: Oblak, P. New concept of morphogenesis of cleft lip and alveolus and palate. J. Maxillofac. Surg. 3: 182, 1975.
references: Oblak, P. Das physiologische Wechlspiel der Mundhoelenmuskeln und seine Wirkung auf die Entwicklung der Spaltregion. In G. Pfeifer (Ed.), Lippen-Kiefer-Gaumenspalten. Stuttgart: Thieme, 1982. Pp. 121–123.
references: Oblak, P. The importance of nasal airways in cleft patients. In J. Bardach and H. Morris (Eds.), Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders, 1990. Pp. 681–688.
references: Precius, D. S., and Delaire, J. Clinical observations of cleft lip and palate. Oral Surg. Oral Med. Oral Pathol. 75: 141, 1993.
references: Koželj, V. Changes produced by presurgical orthopedic treatment before cheiloplasty in cleft lip and palate patients. Cleft Palate Craniofac. J. 36: 515, 1999.
references: Talmat, J. C. Nasal malformations associated with unilateral cleft lip. Scand. J. Plast. Reconstr. Hand Surg. 27: 183, 1993.