Montreal Children's Hospital Formula for Nasoalveolar Molding Cleft Therapy
ABSTRACT : For cleft teams that use nasoalveolar molding for presurgical treatment of cleft lips, the determination of desired cleft-nasal height correction is a subjective assessment. The latter, however, is complicated by a noncleft nasal height that itself is depressed by the shifted nasal pyramid native to the deformity. The authors introduce a simple formula based on the Pythagorean theorem to estimate the corrected height of the nose as an objective guide for the endpoint of nasoalveolar molding therapy.
: Nasal impressions of 20 consecutive patients with unilateral cleft lips who underwent nasoalveolar molding therapy were analyzed. Using identified landmarks on pre-nasoalveolar molding impressions, the Montreal Children's Hospital formula was used to estimate the corrected height of the noncleft nostril (ideal corrected nasal height) as measured on the impressions after nasoalveolar molding therapy had verticalized the nasal pyramid. Statistical analysis was performed using the Pearson correlation test to determine the predictive value of the formula.
: Twenty patients were included in the study. Analysis demonstrated a statistically significant positive correlation (high degree) between predicted nasal heights (ideal corrected nasal height) and those measured following completion of nasoalveolar molding therapy (r = 0.760, p < 0.01).
: The Montreal Children's Hospital formula may serve as a useful tool to predict the corrected nasal height (ideal corrected nasal height) as a benchmark for cleft side nasal correction with nasoalveolar molding. The authors hope it will provide cleft teams, especially those beginning to use nasoalveolar molding, with an objective measure to guide nasoalveolar molding treatment.
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ABSTRACT: Nasoalveolar molding was developed to improve dentoalveolar, septal, and lower lateral cartilage position before cleft lip repair. Previous studies have documented the long-term maintenance of columella length and nasal dome form and projection. The purpose of the present study was to determine the effect of presurgical nasoalveolar molding on long-term unilateral complete cleft nasal symmetry. A retrospective review of 25 consecutively presenting nonsyndromic complete unilateral cleft lip-cleft palate patients was conducted. Fifteen patients were treated with presurgical nasoalveolar molding for 3 months before surgical correction, and 10 patients were treated by surgical correction alone. The average age at the time of follow-up was 9 years. Four nasal anthropometric distances and two angular relationships were measured to assess nasal symmetry. All six measurements demonstrated a greater degree of nasal symmetry in nasoalveolar molding patients compared with the patients treated with surgery alone. Five symmetry measurements were significantly more symmetric in the nasoalveolar molding patients and one measurement demonstrated a nonsignificant but greater degree of symmetry compared with the patients treated with surgery alone. The data demonstrate that the lower lateral and septal cartilages are more symmetric in the nasoalveolar molding patients compared with the surgery-alone patients. Furthermore, the improved symmetry observed in nasoalveolar molding-treated noses during the time of the primary surgery is maintained at 9 years of age.Plastic and Reconstructive Surgery 04/2009; 123(3):1002-6. DOI:10.1097/PRS.0b013e318199f46e · 3.33 Impact Factor
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ABSTRACT: Patients with bilateral cleft lip-cleft palate have nasal deformities including reduced nasal tip projection, widened ala base, and a deficient or absent columella. The authors compare the nasal morphology of patients treated with presurgical nasoalveolar molding followed by primary lip/nasal reconstruction with age-matched noncleft controls. A longitudinal, retrospective review of 77 nonsyndromic patients with bilateral cleft lip-cleft palate was performed. Nasal tip protrusion, alar base width, alar width, columella length, and columella width were measured at five time points spanning 12.5 years. A one-sample t test was used for statistical comparison to an age-matched noncleft population published by Farkas. All five measurements demonstrated parallel, proportional growth in the treatment group relative to the noncleft group. The nasal tip protrusion, alar base width, alar width, columella length, and columella width were not statistically different from those of the noncleft, age-matched control group at age 12.5 years. The nasal tip protrusion also showed no difference in length at 7 and 12.5 years. The alar width and alar base width were significantly wider at the first four time points. This is the first study to describe nasal morphology following nasoalveolar molding and primary surgical repair in patients with bilateral cleft lip-cleft palate through the age of 12.5 years. In this investigation, the authors have shown that patients with bilateral cleft lip-cleft palate treated at their institution with nasoalveolar molding and primary nasal reconstruction, performed at the time of their lip repair, attained nearly normal nasal morphology through 12.5 years of age.Plastic and Reconstructive Surgery 04/2011; 127(4):1659-67. DOI:10.1097/PRS.0b013e31820a64d7 · 3.33 Impact Factor
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ABSTRACT: The principle objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. This enables the surgeon and the patient to enjoy the benefits associated with a repair of a cleft deformity that is of minimal severity. Retraction of the premaxilla, presurgical elongation of the columella, correction of the nasal cartilage deformity, alignment of the cleft alveolar segments, increase in the surface area of the nasal mucosal lining, up-righting of the columella, and achieving close approximation of the cleft lip segments at rest result from gentle application of forces through the NAM appliance. Preservation of these presurgical changes is achieved through the coordinated and modified surgical technique of the primary cleft repair.Clinics in Plastic Surgery 05/2004; 31(2):149-58, vii. DOI:10.1016/S0094-1298(03)00140-8 · 1.35 Impact Factor