title: Comparative Study of Early Secondary Nasal Revisions and Costs in Patients With Clefts Treated With and Without Nasoalveolar Molding.
abstract: The present study aims to determine the risk of early secondary nasal revisions in patients with complete unilateral and bilateral cleft lip and palate (U/BCLP) treated with and without nasoalveolar molding (NAM) and examine the associated costs of care. A retrospective cohort study from 1990 to 1999 was performed comparing the risk of early secondary nasal revision surgery in patients with a CLP treated with NAM and surgery (cleft lip repair and primary surgical nasal reconstruction) versus surgery alone in a private practice and tertiary level clinic. The NAM treatment group consisted of 172 patients with UCLP and 71 patients with BCLP, whereas the non-NAM-prepared group consisted of 28 patients with UCLP and 5 with BCLP. The risk of secondary nasal revision for patients with UCLP was 3% in the NAM group and 21% in the non-NAM group. The risk of secondary nasal revision for patients with BCLP was 7% in the NAM group compared with 40% in the non-NAM group. Using multicenter averages, the non-NAM revision rates were calculated at 37.8% and 48.5% for U/BCLP, respectively. Applying these risks of revision, NAM treatment led to an estimated savings of between $491 and $4893 depending on the type of cleft. In conclusion, NAM can reduce the number of early secondary nasal revision surgeries and, therefore, reduce the overall cost of care.
authors.affiliation: *Department of Plastic Surgery, New York University Langone Medical Center, New York, NY †Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Parit A
authors.initials: PA
authors.lastname: Patel
authors.forename: Marcie S
authors.initials: MS
authors.lastname: Rubin
authors.forename: Sean
authors.initials: S
authors.lastname: Clouston
authors.forename: Frank
authors.initials: F
authors.lastname: Lalezaradeh
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Brecht
authors.forename: Court B
authors.initials: CB
authors.lastname: Cutting
authors.forename: Pradip R
authors.initials: PR
authors.lastname: Shetye
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Warren
authors.forename: Barry H
authors.initials: BH
authors.lastname: Grayson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D013997:Time Factors