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Title The NAM (Nasal Alveolar Molding)appliance is effective in providing symmetrical nasal outcomes in complete unilateral cleft lip and palate.
Clinical Question Does pre-surgical nasal molding with NAM appliance improve nasal symmetry in complete unilateral cleft lip and palate patients compared to surgery alone?
Clinical Bottom Line Pre-surgical nasal molding with an NAM appliance can improve nostril symmetry in complete unilateral cleft lip and palate patients when compared to surgery alone.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22997519 Williams/201228 nasal molding cases and 14 control casesComparative study
Key resultsThis study was conducted on 42 subjects, out of the 42, 28 patients underwent pre-surgical nasal molding without taping prior to lip repair, while 14 patients did not undergo any pre-surgical orthopedics and only primary lip repair according to Millard’s procedure. The mean ages for pre-surgical records were 2.8 weeks for Nasal molding group and 2.6 for control group, mean ages for post surgical records were 6.5 months for nasal molding and 6.9 months for control group. Both nostril height-width ratios and alar groove height ratios were performed. For statistical analysis, all ratio level measurements at each time point were compared with Student's t-tests. Shapiro- Wilk test confirmed normality for presurgical and postsurgical data at P<.05. For post-surgical ratios (OCNWR) a statistically significant difference was found between the nasal molding group and the control group at P<.01. The mean OCNWR was 1.46 for the nasal molding group and 1.91 for the control group. 1.0 numerical mean, would represent the highest achievable symmetry between sides. Since the nasal molding group was closer to 1.0 it can assumed that more symmetrical outcomes were achieved with nasal molding . Not much statistical difference was found in Alar groove height (OCNAR) which was 1.10 for nasal molding and 1.13 for control group. The results of this study conclude that pre-surgical nasal molding with NAM appliance improves nasal symmetry than surgery alone
Evidence Search The following search strategy was used in Pub Med: NAM appliance, Pre-surgical nasal molding for complete unilateral cleft lip and palate.
Comments on
The Evidence
These studies represent a full spectrum of patients with unilateral complete cleft lip and palate. The criteria for the testing were explicit and credible. The diagnostic work-up was comprehensive and consistently applied. There were no follow up studies. There were no apparent competing interests of the authors.
Applicability The study participants represented a full spectrum of complete unilateral cleft lip and palate patients. The pre-surgical use of the NAM appliance produced better nasal symmetry than surgery alone.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords NAM appliance, Cleft lip, cleft palate, Nasal molding appliance
ID# 2588
Date of submission: 09/03/2013spacer
E-mail divya.nagaraj@ucdenver.edu
Author Divya Nagaraj
Co-author(s) e-mail
Faculty mentor/Co-author Ronald N. Brown, DDS
Faculty mentor/Co-author e-mail ronald.brown@ucdenver.edu
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