Pre-surgical nasoalveolar molding for complete unilateral cleft lip and palate. Scoping review

Macarena Garrido; Michelle Cataldo; Cynthia Dabed; Darling Rivera

Macarena Garrido Facultad de Odontología de la Universidad de Valparaíso, Valparaíso, Chile. http://orcid.org/0009-0006-3113-2534
Michelle Cataldo Especialidad de Ortodoncia y Ortopedia Dentomaxilofacial,Especialidad de Ortodoncia y Ortopedia Dentomaxilofacial, Universidad de Chile, Santiago, Chile. |Servicio de Salud Metropolitano Occidente, Santiago, Chile. http://orcid.org/0009-0007-3453-638X
Cynthia Dabed Especialidad de Ortodoncia y Ortopedia Dentomaxilofacial, Universidad de Chile, Santiago, Chile. | Fundación Gantz, Pudahuel, Santiago, Chile. http://orcid.org/0009-0002-0100-5455
Darling Rivera Fundación Gantz, Pudahuel, Santiago, Chile. | Hospital Dr. Exequiel González Cortés, Miguel, Santiago, Chile. http://orcid.org/0000-0002-0994-9373

Keywords: Cleft lip, Cleft palate, Nasoalveolar molding, Orthopedic procedures, Therapeutics, Systematic review

Abstract

Introduction: Cleft lip and palate is a frequent congenital malformation with a significant impact on facial function and aesthetics. Pre-surgical nasoalveolar molding (PNAM) emerged as an early orthopedic technique to correct them. Objectives: To describe the state of the art of nasoalveolar molding in a pre-surgical treatment of unilateral complete cleft lip and palate and its benefits.
Material and Methods: A systematic review was conducted in PubMed and Scopus, using the PICO strategy and PRISMA guidelines, focusing on studies published between 2020 and 2024 that evaluated PNAM in unilateral complete clefts, in English and Spanish, excluding single cases, incomplete, bilateral clefts, and syndromic patients. The mesh and boolean terms used were "cleft lip," "cleft palate," "molding" AND "nasoalveolar."
Results: Of a total of 695 studies, 8 articles were selected that met the inclusion criteria. Benefits of PNAM in correcting cleft lip and palate were observed, including: (1) improvements in nasal symmetry, (2) reduction of the alveolar cleft, and (3) alignment of the alveolar segments, based on the principle of neonatal plasticity. This treatment facilitates primary surgery and dental alignment, although with significant variability due to the lack of standardized protocols. Additionally, PNAM reduces the psychological and financial burden on families, improving the quality of life of the patients.
Conclusions: PNAM is a useful technique in the early orthopedic management of cleft lip and palate, offering aesthetic and functional benefits in the immediate, short, and long term. However, further clinical studies are needed to support its long-term effectiveness and to promote the standardization of protocols.

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References

1. Shaik N, Eggula A, Pudi S, Yemineni BC, Jagati S, Cheduravally TR. Presurgical Orthopedic Nasoalveolar Molding in Cleft Lip and Cleft Palate: Case Report. Int J Clin Pediatr Dent. 2023;16(4):659-662. https://doi.org/10.5005/jp -journals-10005-2487. PMID: 37731793; PMCID: PMC10507294.

2. Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V. Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review. J Clin Med. 2024;13(7):2090. https://doi.org/10.3390/jcm13072090. PMID: 38 610855; PMCID: PMC11012824.

3. Luyten J, De Roo NMC, Christiaens J, Van Overberghe L, Temmerman L, De Pauw GAM. Rapid maxillary expansion vs slow maxillary expansion in patients with cleft lip and/or palate: a systematic review and meta-analysis. Angle Orthod. 2023;93(1):95-103. https://doi.org/10.2319/030122-188.1.

4. Ministerio de Salud. Guía Clínica AUGE fisura labiopalatina. 3ra ed. Chile: Ministerio de Salud; 2015. 5-71.

5. Grayson BH, Shetye PR. Presurgical naso-alveolar moulding treatment in cleft lip and palate patients. Indian J Plast Surg. 2009;42 Suppl(Suppl):S56-61. https://doi.org/10.4103/ 0970-0358.57188. PMID: 19884682;

6. Ahsanuddin S, Ahmed M, Slowikowski L, Heitzler J. Recent Advances in Nasoalveolar Molding Therapy Using 3D Technology. Craniomaxillofac Trauma Reconstr. 2022;15(4):387-396. https://doi.org/10.1177/19433875211044622. Epub 2021 Sep 3. PMID: 36387323; PMCID: PMC9647384.

7. Al-Qatami F, Avinoam SP, Cutting CB, Grayson BH, Shetye PR. Efficacy of postsurgical nostril retainer in patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding and primary cheiloplasty-rhinoplasty. Plast Reconstr Surg. 2022;150(3):623-629. https://doi.org/10.1097/PRS.0000000000009426.

8. Dinh TTN, Van Nguyen D, Dien VHA, Dong TK. Effectiveness of Presurgical Nasoalveolar Molding Appliance in Infants With Complete Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J. 2022;59(8):995-1000. https://doi.org/10.1177/10556656211026493. Epub 2021 Jun 24. PMID: 34164995.

9. Thakur S, Singh A, Diwana VK, Rani A, Thakur NS. Dynamic changes in nasal symmetry after presurgical nasoalveolar molding in infants with complete unilateral cleft lip and palate. Afr J Paediatr Surg. 2020;17(1-2):1-4. https://doi.org/10.4103/ajps.AJPS_5_18. PMID: 33106444; PMCID: PMC7818664.

10. Lautner N, Raith S, Ooms M, Peters F, Hölzle F, Modabber A. Three-dimensional evaluation of the effect of nasoalveolar molding on the vo-lume of the alveolar gap in unilateral clefts. J Craniomaxillofac Surg. 2020;48(2):141-147. https://doi.org/10.1016/j.jcms.2019.12.012.

11. Zheng J, He H, Kuang W, Yuan W. Novel Three-Dimensional Coordinate System to Analyze Alveolar Molding Effects of Pre-Surgical Naso-alveolar Molding on Infants With Non-Syndromic Unilateral Cleft Lip and Palate. J Craniofac Surg. 2020;31(3):653-657. https://doi.org/10.1097/SCS.00 00000000006148. PMID:3198 5599.

12. Thakur S, Jishad C, Singhal P, Chauhan D. Comparative clinical evaluation of modified and conventional Grayson's presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate. Dent Res J (Isfahan). 2021¿;18:68. PMID: 34584646; PMCID: PMC8428282.

13. Ocak I, Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. Effects of nasoalveolar molding on maxillary arch dimensions and malocclusion characteristics in primary dentition patients with cleft lip and palate. Int J Paediatr Dent. 2024;34(1):94-101. https://doi.org/10.1111/ipd.131 02. Epub 2023 Jul 3. PMID: 37351851.

14. Parhofer R, Rau A, Strobel K, Gölz L, Stark R, Ritschl LM, Wolff KD, Kesting MR, Grill FD, Seidel CL. The impact of passive alveolar molding vs. nasoalveolar molding on cleft width and other parameters of maxillary growth in unilateral cleft lip palate. Clin Oral Investig. 2023;27(9):5001-5009. https://doi.org/10.1007/s 00784-023-05119-7. Epub 2023 Jun 23. PMID: 373 53667; PMCID: PMC10492684..

15. Titiz Yurdakal S, Oral E, Gelgör İE. Outcomes of Presurgical Nasoalveolar Molding using Modified Nostril Retainers in Patients with Unilateral Cleft Lip and Palate at an Average Follow-up of 2 Years. Turk J Orthod. 2023;36(4):254-260. https://doi.org/10.4274/TurkJOrthod.2023.2022.98.