title: Nasal changes after presurgical nasoalveolar molding (PNAM) in the unilateral cleft lip nose.
abstract: OBJECTIVE
  Nasal reconstruction for patients with unilateral cleft lip and palate (UCLP) is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding (PNAM) was introduced to reshape the cleft nasal structures prior to lip repair. This study analyzed two-dimensional nasal changes before and after PNAM in patients with complete UCLP.
  
  
  METHODS
  Thirty UCLP patients (19 males; 11 females) who received PNAM before lip repair were included in this study. PNAM was applied for 100 days. Nasal casts were obtained before and after PNAM. Frontal and 45° standardized digital photographs were taken from all casts, and a photogrammetric analysis (16 linear, six angular, and two area measurements) was performed. Paired Student's t tests were used to search for differences by time, and time versus side (cleft versus noncleft).
  
  
  RESULTS
  Significant reduction of cleft columella deviation with an increase in columella length, nostril height, and axial inclination on the cleft side were recorded. This resulted in an increase in the projection of the nasal tip. The noncleft measurements remained without significant changes. The cleft nostril area increased significantly more than the noncleft side by 90% with PNAM treatment. Significant normal growth changes were observed in nasal width and nasal height.
  
  
  CONCLUSIONS
  A favorable reshaping of the nose after PNAM was achieved, resulting in an improvement in form before lip surgery. These changes lead to improved nasal symmetry before primary lip and nasal reconstruction in UCLP patients.
authors.affiliation: Rush Craniofacial Center, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Gomez
authors.forename: Sean T
authors.initials: ST
authors.lastname: Donohue
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Figueroa
authors.forename: John W
authors.initials: JW
authors.lastname: Polley
mesh_terms: D000293:Adolescent; D000539:Alveolar Process / Q000002:abnormalities*; D000543:Alveoloplasty; D059925:Anatomic Landmarks; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008297:Male; D055171:Nasal Cartilages / Q000002:abnormalities*; D009666:Nose / Q000002:abnormalities*; D019637:Orthopedic Procedures; D010158:Palatal Obturators; D010780:Photogrammetry; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome