The Role of Nasoalveolar Molding: A 3D Longitudinal Analysis

Objectives: Nasoalveolar molding (NAM) is regarded as an important step to reduce the alveolar segments into proper alignment and to improve nasal symmetry. The goal of this study was using 3D analytic image data to provide a strict longitudinal progression of NAM treatment over time.
Methods: Upon IRB approval, 20 patients with complete unilateral cleft lip and palate (UCLP) were prospectively recruited with the protocol of Grayson’s NAM. Stage 1 involved adjustment of the alveolar segments, while Stage 2 added nasal stents. 3D stereophotogrammetric images (3dMD) were obtained prior to NAM initiation and weekly until the end of NAM treatment. The cleft lip area, bilateral nostril area, and the distances of bilateral nostril height and width were measured on the obtained images based on recognizable anatomical landmarks. Patients were divided into three groups according to the age at beginning of NAM treatment. NAM treatment progress was assessed in the Cleft (C) side and the contralateral Non-cleft (N) side for each subject at 3 intervals: pre-treatment, post stage 1, and post stage 2.
Results: There was significant difference in the C/N ratio of nostril area, width and height pre-treatment(0.9±0.3, 4.1±1.1, and 0.5±0.2) and throughout stage 1 of treatment(1.1±0.3, 2.2±0.6, and 0.8±0.2). There was significant difference in the C/N ratio of nostril area, width and height pre-stage 2 treatment(1.1±0.3, 2.2±0.6, and 0.8±0.2) and throughout stage 2 of treatment(1.8±0.3, 1.8±0.4, and 1.2±0.1). Patients who started their treatment at different ages finally got almost the same C/N ratios in nostril area(1.8±0.3, 1.7±0.3, and 1.7±0.2), width(2.0±0.3, 1.8±0.4, and 1.6±0.2) and height(1.2±0.1, 1.2±0.2, and 1.2±0.1). In general, the same level of correction was eventually achieved for all age groups at end of treatment, nostril height (1.2) and nostril area (1.8).
Conclusions: Longitudinal 3D measurement provided detailed and valuable information regarding the pace of changes achieved in the different stages of NAM therapy. NAM achieved significant improvement in measures of cleft width and nasal form in all patients, regardless of the initial age of treatment.