title: Is presurgical nasoalveolar molding therapy more effective in unilateral or bilateral cleft lip-cleft palate patients?
abstract: BACKGROUND
  The purpose of this study was to compare the efficacy of presurgical nasoalveolar molding in treating unilateral versus bilateral cleft lip–cleft palate patients.
  
  
  METHODS
  A blinded, retrospective study was conducted with 16 unilateral and 13 bilateral cleft lip–cleft palate patients. Pretreatment and posttreatment facial and intraoral impressions were used to compare soft- and hard-tissue changes.
  
  
  RESULTS
  Nasoalveolar molding therapy improves nasal angle in unilateral (p = 0.010) and bilateral cleft lip–cleft palate (p = 0.001) patients, and improves nostril width in unilateral (p = 0.005) and bilateral cleft lip–cleft palate (p = 0.028) patients. Treatment significantly improves nostril breadth only in unilateral cleft lip–cleft palate patients (p = 0.005). Compared with bilateral cleft lip–cleft palate patients, unilaterally affected patients were more asymmetric before and after nasoalveolar molding therapy. Nasoalveolar molding more effectively increases columellar height (p = 0.002) and columellar width (p = 0.002) in the bilateral cleft lip–cleft palate group. Although starting bialar widths did not significantly differ between the two groups, nasoalveolar molding significantly decreased bialar width only in unilateral cleft lip–cleft palate patients (p = 0.032). When the intersegment alveolar cleft distances of the bilateral cleft lip–cleft palate patients were summed, an improvement similar to that in unilateral cleft lip–cleft palate patients was observed. Furthermore, nasoalveolar molding appeared to prevent alveolar width widening as patients continued to grow.
  
  
  CONCLUSIONS
  There are differences in efficacy between unilateral and bilateral cleft lip–cleft palate patients undergoing nasoalveolar molding. Understanding these differences may help physicians and dentists better shape expectations.
authors.affiliation: Los Angeles, Calif. From Children's Hospital Los Angeles.
authors.forename: Sheila S
authors.initials: SS
authors.lastname: Nazarian Mobin
authors.forename: Ashley
authors.initials: A
authors.lastname: Karatsonyi
authors.forename: Evan N
authors.initials: EN
authors.lastname: Vidar
authors.forename: Simon
authors.initials: S
authors.lastname: Gamer
authors.forename: John
authors.initials: J
authors.lastname: Groper
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hammoudeh
authors.forename: Mark M
authors.initials: MM
authors.lastname: Urata
mesh_terms: D000539:Alveolar Process; D002971:Cleft Lip / Q000628:therapy*; D002972:Cleft Palate / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009666:Nose; D009971:Orthodontics, Corrective / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome