Three-dimensional longitudinal assessment of nasal development with and without Nasoalveolar molding therapy in cleft lip and palate patients

Abstract

Background: Grayson-type presurgical nasoalveolar molding (PNAM) is an established method in presurgical infant orthopedics. This study compared PNAM therapy with conventional palatal plates across cleft types, focusing on nasal morphology. Methods: Seventy-two patients with non-syndromic unilateral (UCLP) and bilateral cleft lip and palate (BCLP) were followed from birth to two years. Three-dimensional (3D) models of the perinasal area were obtained via cast-based scans or 3D photographs; right-sided UCLP cases were mirrored to the left. Two independent reviewers analyzed anatomical landmarks with excellent inter-rater reliability (ICC = 0.88). Initial and two-year measurements were compared between PNAM (NAM group) and conventional treatment (non-NAM group). Results: Of the 72 patients, 46 had UCLP and 26 BCLP. In BCLP, NAM therapy promoted greater columella elongation from 2.1 mm at T0 to 5.2 mm at T3 compared to a change from 2.4 mm to 3.5 mm in the non-NAM group (p = 0.300). In UCLP, NAM was also associated with increases in columella (p = 0.387) and improved columella deviation angles, from a median of 48.1° at T0 to 85.6° at T3, while non-NAM showed a modest increase from 70.6° to 79.1°, (p = 0.167) Significant reductions were observed cleft-side nostril length (p = 0.027) and width (p = 0.029). Conclusion: This study, using 3D imaging, demonstrates the clinically relevant capability of PNAM to improve nasal morphology compared to conventional treatment, potentially enhancing primary cheiloplasty outcomes. The longitudinal design three-dimensionally tracks preoperative and postoperative changes over two years, with further investigation needed for long-term stability.