Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial

A survey on nasoalveolar moulding treatment practices at cleft centres across India

Background

The purpose of this study is to assess the current protocols followed in the practice of NAM treatment for patients with cleft lip and palate across different comprehensive centres in India.

Design

Cross sectional questionnaire based study.

Method

Comprehensive cleft teams across India were invited to participate in this survey. The questionnaire was developed over four stages, with a panel of eight members. The developed questionnaire consisted of 29 questions that included demographic details, decision-making process, treatment protocols, experiences with treating patients, difficulties and complications encountered during treatment. The results were reported descriptively in percentages.

Results

Of the 46 teams, 39 teams (85%) reported offering NAM before lip surgery, while 15% (n = 7) teams did not offer NAM. Of these 39 teams, almost half (49%, n = 19) of the teams were providing NAM to less than 20% of their patients, 28% (n = 11) of the teams were providing treatment to more than 50%, and the remaining respondents reported (23%, n = 9) providing NAM to 21%-50% of their patients. There is a consensus that NAM is beneficial for both unilateral and bilateral clefts, with the Grayson's method as the most commonly used technique. While there is general agreement on their effectiveness, 15% of participants were unsure. The most frequently reported side effects were cheek and mucosal irritation. Despite these issues, all respondents would recommend NAM treatment.

Conclusion

The survey demonstrated a strong consensus among centers regarding most aspects of NAM treatment. Notably, all respondents expressed their willingness to recommend NAM to their friends and family.

Cleft Palate and Presurgical Orthopedics: A Systematic Review and Meta-Analysis of Intra-Arch Dimensions During the First Year of Life

Background: This systematic review and meta-analysis aimed to investigate the effects of presurgical orthopedics (PSO) on maxillary arch dimensions in infants with cleft lip and palate during the first year of life. Methods: The review was conducted following PRISMA guidelines. A comprehensive electronic search was performed in MEDLINE, Embase, Cochrane, Scopus, and Google Scholar databases, supplemented by manual searching. Two reviewers independently conducted study selection, data extraction, quality assessment, and risk of bias evaluation. Results: Five studies were included in the meta-analysis. Quantitative analysis was performed based on the primary outcomes. The estimate was calculated using a random-effects model and z distribution (95% confidence interval (CI)). The results showed similar alveolar cleft widths (mean difference, -3.06; 95% CI, -8.03 to 2.70, p = 0.30, I2 = 99%) with clinical differences in favor of PSO, and comparable posterior cleft widths (mean difference, -0.88; 95% CI, -2.06 to 0.30, p = 0.14, I2 = 89%) with and without PSO in CLP babies. Conclusions: This meta-analysis found no statistically significant effects of presurgical orthopedic treatment on maxillary arch dimensions in infants with cleft lip and palate during the first year of life. Further high-quality randomized controlled trials are needed to definitively establish the efficacy of PSO.

Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate

Background

Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child.

Aim

To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect.

Material and Methods

The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree.

Discussion

For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc.

Conclusion

The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.