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.
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.
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.