Topic | Study | Year of publication | Study design | Evidence level | Cleft | Aim of the study | Sample size | Control group | Method assessment | Effect of nasal molding | Effect of alveolar molding | Other outcomes | Follow-up |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Impact on primary repair surgeries | Santiago et al. [36] | 1998 | Retrospective blind study | III | UCLP | Compare the need of bone graft between patients who undergo NAM + GPP and no-NAM | 32 (NAM + GPP: 18) | No-NAM: 14 | Clinical assessment | - |
NAM group: 8 required bone graft; no-NAM group: all required bone graft |
- | Before surgery |
Rubin et al. [37] | 2015 | Quasi-experimental study | III | UCLP | Assessment by the surgeon: necessity of secondary nasal revision surgery with and without NAM |
176 of the 731 surgeons accepted to answer the survey. NAM: 10; no-NAM: 10 |
No-NAM: 10 | Two-dimensional photographs |
Necessity secondary nasal revision surgery: NAM group: 3%; no-NAM group: 21%. Not statistically significant |
- | Patient with NAM cost $500 less | Before the surgery | |
Broder et al. [38] | 2016 | Prospective non-randomized study | II | UCLP BCLP | Examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction |
NAM: 62; No-NAM: 48 |
- | Two-dimensional photographs | Better postsurgery outcomes in the NAM group | - | - | 13 months | |
Nasal stent impact on nasal and alveolar molding | Punga and Sharma [39] | 2013 | Prospective study | II | UCLP BCLP | Comparison between treatment with a presurgical appliance with and without nasal stent | 20 (with nasal stents: 10; without nasal stents: 10) | - | Two-dimensional photographs | Increase the columella length with a nasal stents | - | - | Every 2 - 3 weeks until lip repair |
Monasterio et al. [40] | 2013 | Prospective study | II | UCLP | Compare two techniques: nasal elevator and NAM-Grayson |
40 (NAM Grayson: 20; nasal elevator: 20) |
- | Two-dimensional photographs casts | Two methods improved significantly the nasal asymmetry | Two methods reduced significantly the cleft width | - | 3 months, (before the surgery) | |
Isogawa et al. [41] | 2010 | Prospective study | II | UCLP | Compare effect between Hotz plate modified by adding a nasal stent and modified NAM | 10 (NAM: 5; Hotz: 5) | - | Casts | Favourable effect obtains with PNAM | Favourable effect with both techniques | - |
Around 130 days (4 months) |
|
Sasaki et al. [42] | 2012 | Prospective study | II | UCLP | Compare the effect between appliance with NAM and passive method with only action of alveolar plate |
28 (NAM: 13; Hotz plate: 15) |
Control with the symmetric nostril | Two-dimensional photographs casts | Better naris morphology in the NAM group | Cleft gap smaller in the NAM group | - | Just before the surgery and after | |
Nakamura et al. [43] | 2009 | Prospective study | II | UCLP | Assess outcome nasal correction after NAM, compare with Hotz plate | 30 (NAM: 15; Hotz: 15) | - | Two-dimensional photographs photographs | Better nasal shape in the NAM group | - | - | 1 and 5 years post-operative | |
Kozel [44] | 2007 | Retrospective study | III | UCLP | Compare presurical orthopaedic without nasal stents and with stents |
With nasal stents: 16; without nasal stents: 16 |
- | Two-dimensional photographs photographs | Nose was more symmetric with nasal stents | - | - | 1 year after lip repair | |
Nasal molding improvment with NAM | López-Palacio et al. [45] | 2012 | Prospective study | II | UCLP | Nasal improvement with NAM | 17 | Non-cleft nostril | Two-dimensional photographs of casts | Improved of nasal tip projection, alar cartilage depression and | - | - | Before the primary rhinocheiloplasty (103 days), |
Gomez et al. [46] | 2012 | Prospective study | II | UCLP | Nasal improvement with NAM | 30 | - | Two-dimensional photographs of casts | Reduction of cleft columella deviation, improved columella length | - | - | Before lip surgery (146 days) | |
Nasal and alveolar molding improvment with NAM | Keçik and Enacar [47] | 2009 | Prospective study | III | UCLP | NAM effect on nasal and alveolar tissues | 22 | - | Two-dimensional photographs scan on cast | Reduction alar base width and the deviation of the columella | Reduction of the cleft width, arch length | - | 6 months (before surgeries) |
Jaeger. et al. [48] | 2007 | Prospective study | III | UCLP | Evaluate nasal symmetry, gap reduction | 11 | - | Two-dimensional photographs | Improvement nasal symmetry and nostril shape | Cleft gap reduction | - | After NAM treatment (max 23 weeks) | |
Pai et al. [49] | 2005 | Case-series | III | UCLP | Evaluate nasal symmetry and width | 57 | Non affected side | Two-dimensional photographs | Effect on nasal symmetry, height, and columella angle | - | Relapse of nostril shape in width | 1 year | |
Ezzat et al. [50] |
2007 | Prospective, blinded measurement study | II | UCLP | Evaluate improvement alveolar cleft and nose symmetry | 12 | - | Intra-oral and extra-oral casts | Nasal symmetry improvement | Cleft gap reduction | - | Mean 110 days | |
Shetty et al. [51] | 2012 | Prospective study | II | UCLP | Evaluation of the NAM treatment depending on the moment when the treatment is started | 45 | No-NAM: 15 | Two-dimensional photographs, dento-facial impression | Nasal measurements are improved with NAM group | - | - | Before NAM treatment, before surgery, at 18 months | |
Shetty et al. [52] |
2016 | Prospective study | II | UCLP | To compare the effectiveness of NAM in infants before and after 6 months of age |
150 (birth to 1 month: 50; 1 to 6 months: 50; 6 months to 1 year: 50 |
- | Cast landmark | Nasal height, nasal dome height, and columella height reduce with NAM. | Intersegment distance reduced | Patients who presented for treatment before 1 month of age benefited the most | 1 year | |
Evolution of the NAM procedure | Chang et al. [58] | 2014 | Randomized prospective, single blind trial | II | UCLP | Compare traditional (Grayson) NAM and modified (Figueroa) NAM | 30 (Grayson NAM: 15; Figueroa NAM: 15) | - | Two-dimensional photographs | Similar results in term of nasal result | - | - | Before surgery, one week after surgery and 6 month |
Liao et al. [59] | 2012 | Retrospective, blind study | II | UCLP | Compare traditional (Grayson) NAM and modified (Figueroa) NAM | 63 (Grayson NAM: 31; Figueroa NAM: 32) | - | Two-dimensional photographs | Grayson NAM was more effective to reduce nostril width but required more corrections. | - | More ulcerations with Grayson NAM, | 15 weeks |
UCLP = unilateral cleft lip and/or palate; BCLP = bilateral cleft lip and/or palate; PNAM = presurgical nasoalveolar molding; n = number of patients. |