title: Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry:  a call for unified research.
abstract: BACKGROUND
  In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term.
  
  
  METHODS
  A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch.
  
  
  RESULTS
  The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects.
  
  
  CONCLUSIONS
  Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Groningen, The Netherlands From the Department of Otorhinolaryngology/Head and Neck Surgery, the Department of Rehabilitation Medicine, Center for Rehabilitation, and the Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen.
authors.forename: Perry
authors.initials: P
authors.lastname: van der Heijden
authors.forename: Pieter U
authors.initials: PU
authors.lastname: Dijkstra
authors.forename: Cees
authors.initials: C
authors.lastname: Stellingsma
authors.forename: Bernard F
authors.initials: BF
authors.lastname: van der Laan
authors.forename: Astrid G W
authors.initials: AGW
authors.lastname: Korsten-Meijer
authors.forename: Sieneke M
authors.initials: SM
authors.lastname: Goorhuis-Brouwer
mesh_terms: D000539:Alveolar Process / Q000002:abnormalities; D002971:Cleft Lip / Q000601:surgery / Q000628:therapy*; D002972:Cleft Palate / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005146:Facial Asymmetry / Q000151:congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D009666:Nose / Q000002:abnormalities* / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome