title: Comparison of two nasoalveolar molding techniques in unilateral complete cleft lip patients: a randomized, prospective, single-blind trial to compare nasal outcomes.
abstract: BACKGROUND
  Nasoalveolar molding became increasingly popular in the 1990s as a means of easing surgery and improving nasal outcomes for cleft lip repairs. In the late 1990s, three orthodontists from our center underwent nasoalveolar molding training: two at the Rush Craniofacial Center, in Chicago; and one at New York University Craniofacial Center. They brought two different nasoalveolar molding techniques back to Chang Gung Craniofacial Center: the modified Figueroa and the modified Grayson techniques. Outcomes following use of these techniques have not previously been compared prospectively.
  
  
  METHODS
  Between May of 2010 and March of 2013, a randomized, prospective, single-blind trial was conducted to compare the number of clinical visits, total costs, complications, and nasal symmetry between the two nasoalveolar molding techniques in 30 patients with unilateral complete cleft lip.
  
  
  RESULTS
  There were no differences between nasoalveolar molding techniques in the number of clinical visits, total costs, nostril height, or nostril area ratio. Preoperatively but after nasoalveolar molding, the nostril width ratio was wider for the Figueroa group than for the Grayson group. Six months after surgical correction, there were no differences in nostril height, nostril width, nasal sill height, or nostril area ratio between nasoalveolar molding methods. Alveolar ulceration occurred more frequently in the Grayson group.
  
  
  CONCLUSIONS
  The modified Grayson technique reduced nostril width more efficiently, but alveolar ulceration was more frequent and no differences in nostril width were found following surgery. Overall, the two nasoalveolar molding techniques produced similar nasal outcomes.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Taoyuan, Taiwan From the Graduate Institute of Biochemical and Biomedical Engineering, College of Engineering, Chang Gung University; and the Craniofacial Research Center, Departments of Medical Research, Plastic Surgery, and Craniofacial Orthodontics, Chang Gung Memorial Hospital.
authors.forename: Chun-Shin
authors.initials: CS
authors.lastname: Chang
authors.forename: Christopher Glenn
authors.initials: CG
authors.lastname: Wallace
authors.forename: Betty Chien-Jung
authors.initials: BC
authors.lastname: Pai
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chiu
authors.forename: Yuh-Jia
authors.initials: YJ
authors.lastname: Hsieh
authors.forename: I-Ju
authors.initials: IJ
authors.lastname: Chen
authors.forename: Yu-Fang
authors.initials: YF
authors.lastname: Liao
authors.forename: Eric Jen-Wein
authors.initials: EJ
authors.lastname: Liou
authors.forename: Philip Kuo-Ting
authors.initials: PK
authors.lastname: Chen
mesh_terms: D000539:Alveolar Process; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003761:Dental Impression Technique; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome
references.citation: Fisher DM, Lo LJ, Chen YR, Noordhoff MS. Three-dimensional computed tomographic analysis of the primary nasal deformity in 3-month-old infants with complete unilateral cleft lip and palate. Plast Reconstr Surg. 1999;103:1826–1834
references.citation: Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36:486–498
references.citation: Gomez DF, Donohue ST, Figueroa AA, Polley JW. Nasal changes after presurgical nasoalveolar molding (PNAM) in the unilateral cleft lip nose. Cleft Palate Craniofac J. 2012;49:689–700
references.citation: Grayson BH, Cutting CB. 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. 2001;38:193–198
references.citation: Chang CS, Por YC, Liou EJ, Chang CJ, Chen PK, Noordhoff MS. Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon’s experience. Plast Reconstr Surg. 2010;126:1276–1284
references.citation: Noordhoff MS, Chen Y, Chen K, et al. The surgical technique for the complete unilateral cleft lip-nasal deformity. Oper Techn Plast Reconstr Surg. 1995;2:167–174
references.citation: Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study. Plast Reconstr Surg. 2004;114:858–864
references.citation: Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac J. 2005;42:658–663
references.citation: Maull DJ, Grayson BH, Cutting CB, et al. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J. 1999;36:391–397
references.citation: Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg. 1993;92:1422–1423
references.citation: Bennun RD, Perandones C, Sepliarsky VA, Chantiri SN, Aguirre MI, Dogliotti PL. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: A 6-year follow-up. Plast Reconstr Surg. 1999;104:616–630
references.citation: Liao YF, Hsieh YJ, Chen IJ, Ko WC, Chen PK. Comparative outcomes of two nasoalveolar molding techniques for unilateral cleft nose deformity. Plast Reconstr Surg. 2012;130:1289–1295