Abdelhalim, M., Abdelmofeed, A., Ramadan, M., Abourizk, M., Moussa, A., ELZOHIRY, M., Aly, K., Elsherbiny, M. (2025). Surgical and Aesthetic Outcome in Complete Cleft Lip Repair; Comparative Study With and Without Nasoalveolar Molding. The Egyptian Journal of Plastic and Reconstructive Surgery, 49(1), 21-33. doi: 10.21608/ejprs.2025.405185
Mohamed Abdelhalim; Ayman M Abdelmofeed; Mohamed Ramadan; Mohamed I Abourizk; Ahmed Moussa; Mohmed ELZOHIRY; Kamal Aly; Mohamed Elsherbiny. "Surgical and Aesthetic Outcome in Complete Cleft Lip Repair; Comparative Study With and Without Nasoalveolar Molding". The Egyptian Journal of Plastic and Reconstructive Surgery, 49, 1, 2025, 21-33. doi: 10.21608/ejprs.2025.405185
Abdelhalim, M., Abdelmofeed, A., Ramadan, M., Abourizk, M., Moussa, A., ELZOHIRY, M., Aly, K., Elsherbiny, M. (2025). 'Surgical and Aesthetic Outcome in Complete Cleft Lip Repair; Comparative Study With and Without Nasoalveolar Molding', The Egyptian Journal of Plastic and Reconstructive Surgery, 49(1), pp. 21-33. doi: 10.21608/ejprs.2025.405185
Abdelhalim, M., Abdelmofeed, A., Ramadan, M., Abourizk, M., Moussa, A., ELZOHIRY, M., Aly, K., Elsherbiny, M. Surgical and Aesthetic Outcome in Complete Cleft Lip Repair; Comparative Study With and Without Nasoalveolar Molding. The Egyptian Journal of Plastic and Reconstructive Surgery, 2025; 49(1): 21-33. doi: 10.21608/ejprs.2025.405185
Surgical and Aesthetic Outcome in Complete Cleft Lip Repair; Comparative Study With and Without Nasoalveolar Molding
1Plastic Surgery Unit, Faculty of Medicine, Benha University
2General Surgery Department, Faculty of Medicine, Benha University
3The Department of Pediatric Surgery, Faculty of Medicine, Mansoura University
Abstract
Background/Purpose: Several studies have been developed to enhance the repair of cleft lip anomaly since it is typically not sufficient in patients with large gaps in the lips. Objective: The purpose of this study is to assess the use of nasoalveolar molding (NAM) as regards the surgical and cosmetic results following full cleft lip surgery. Methods: 44 patients were diagnosed with complete cleft lip and hospitalized to the pediatric surgery department between May 2018 and May 2020 were included in this study. They were divided randomly into two groups; the non-NAM group and the NAM group, each group had 22 patients. Four distinct times were recorded for magnified basal view facial photos: The first visit (T1), the period before to cheiloplasty (T2), the period one month after the cheiloplasty (T3), and the period six months following cheiloplasty (T4). The following measurements were taken directly from the pictures: (1) Nostril height on both sides; (2) Nostril width on both sides; (3) Columella angle on both sides; and (4) Alveolar gap width. Photos with a standard 1:1 ratio were captured. Straight linear measurements were taken on the images. Results: There was a statistically significant narrowing of the alveolar gap in the molded group. The study revealed improved nasal symmetry regarding nasal height, width, and columella angle in molded groups. There was an improvement of results up to six months follow-up with no relapse. The hypertrophic scar risks and notched lip were lower in the molded group. Vermilion volume homogeneity was better in the NAM group. Other parameters of surgical interference like time of surgery, extent of muscle dissection, and surgical difficulty were in favor of the NAM group. Conclusions: Presurgical NAM is an effective procedure in improving the surgical and aesthetic outcomes in complete cleft lip patients.
Fisher M.D., Fisher D.M. and Marcus J.R.: Correction of the cleft nasal deformity: From infancy to maturity. Clinics in Plastic Surgery, 41 (2): 283-99, 2014. 2- Pai BC-J., Ko EW-C., Huang C-S. and Liou EJ-W.: Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study. The Cleft palate-craniofacial journal, 42 (6): 658- 63, 2005. 3- Ijaz A., ORTH M. and ORTH M.: Management of complete bilateral lip and palate cleft with modified presurgical infant Orthopedic plate. Pak Oral Dental J., 23 (2): 131-36, 2003. 4- Mishra B., Singh A.K., Zaidi J., Singh G., Agrawal R. and Kumar V.: Presurgical nasoalveolar molding to correct cleft lip nasal deformity: Experience from northern India. Eplasty, 10, 2010. 5- Grayson B.H. and Wood R.: Preoperative columella lengthening in bilateral cleft lip and palate. Plastic and Reconstructive Surgery, 92 (7): 1422-3, 1993. 6- Millard Jr. D.: A primary camouflage of the unilateral hare look. transactions of the International Society of Plastic Surgeons, 160, 1957. 7- Pham A.M. and Senders C.W.: Management of bilateral cleft lip and nasal deformity. Current opinion in otolaryngology & head and neck surgery, 14 (4): 278-82, 2006. 8- Maull D.J., Grayson B.H., Cutting C.B., Brecht L.L., Bookstein F.L., Khorrambadi D., et al.: Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. The Cleft palate-craniofacial journal, 36 (5): 391-7, 1999. 9- Grayson B.H. and Cutting C.B.: Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. The Cleft palate-craniofacial Journal, 38 (3): 193-8, 2001. 10- Kinouchi N., Horiuchi S., Yasue A., Kuroda Y., Kawai N., Watanabe K., et al.: Effectiveness of presurgical nasoalveolar molding therapy on unilateral cleft lip nasal deformity. Saudi Medical Journal, 39 (2): 169, 2018. 11- Singh A., Thakur S., Singhal P., Diwana V.K. and Rani A.: A comparative evaluation of efficacy and efficiency of Grayson’s presurgical nasoalveolar molding technique in patients with complete unilateral cleft lip and palate with those treated with Figueroa’s modified technique. Contemporary clinical dentistry, 9 (Suppl 1): S28, 2018. 12- Deng X., Zhai J., Jiang J., Li F., Pei X. and Wang H.: A clinical study of presurgical nasoalveolar molding in infants with complete cleft lip and palate. Zhonghua kou qiang yi xue za zhi=Zhonghua kouqiang yixue zazhi=Chinese Journal of Stomatology, 40 (2): 144-6, 2005. 13- Ezzat C.F., Chavarria C., Teichgraeber J.F., Chen J-W., Stratmann R.G., Gateno J., et al.: Presurgical nasoalveolar molding therapy for treating unilateral cleft lip and palate: A preliminary study. The Cleft palate-craniofacial journal, 44 (1): 8-12, 2007. 14- Chang C-S., Por Y.C., Liou EJ-W., Chang C-J., Chen PKT. and Noordhoff M.S.: Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon’s experience. Plastic and reconstructive surgery, 126 (4): 1276-84, 2010. 15- Mancini L., Gibson T.L., Grayson B.H., Flores R.L., Staffenberg D. and Shetye P.R.: Three-dimensional soft tissue nasal changes after nasoalveolar molding and primary cheilorhinoplasty in infants with unilateral cleft lip and palate. The Cleft Palate-Craniofacial Journal, 56 (1): 31-8, 2019. 16- Liao Y-F., Wang Y-C., Chen I-J., Pai C-J., Ko W-C. and Wang Y-C.: Comparative outcomes of two nasoalveolar molding techniques for bilateral cleft nose deformity. Plastic and Reconstructive Surgery, 133 (1): 103-10, 2014. 17- Spengler A.L., Chavarria C., Teichgraeber J.F., Gateno J. and Xia J.J.: Presurgical nasoalveolar molding therapy for treating bilateral cleft lip and palate: A preliminary study. The Cleft palate-craniofacial journal, 43 (3): 321-8, 2006. 18- Rau A., Ritschl L.M., Mücke T., Wolff K-D. and Loeffelbein D.J.: Nasoalveolar molding in cleft care-experience in 40 patients from a single center in Germany. PloS one, 10 (3): e0118103, 2015. 19- Li W., Liao L., Dai J., Zhong Y., Ren L. and Liu Y.: Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: A novel modified presurgical nasoalveolar molding device with retraction screw. Journal of Cranio-Maxillofacial Surgery, 42 (8): 1903-8, 2014. 20- Garfinkle J.S., King T.W., Grayson B.H. and Brecht L.E.: A 12-year anthropometric evaluation of the nose in bilateral cleft lip–cleft palate patients following nasoalveolar molding and cutting bilateral cleft lip and nose reconstruction. Plastic and reconstructive surgery, 127 (4): 1659-67, 2011. 21- Liou EJ-W., Subramanian M. and Chen P.K.: Progressive changes of columella length and nasal growth after nasoalveolar molding in bilateral cleft patients: A 3-year follow- up study. Plastic and Reconstructive Surgery, 119 (2): 642-8, 2007. 22- Lee C.T., Garfinkle J.S., Warren S.M., Brecht L.E. and Grayson B.H.: Nasoalveolar molding improves the appearance of children with bilateral cleft lip–cleft palate. Plastic and Reconstructive Surgery, 122 (4): 1131-7, 2008. 23- Patel P.A., Rubin M.S., Clouston S., Lalezaradeh F., Brecht L.E., Shetye P.R., et al.: Comparative study of early secondary nasal revisions and costs in patients with clefts Egypt, J. Plast. Reconstr. Surg., January 2025 33 treated with and without nasoalveolar molding. Journal of Craniofacial Surgery, 26 (4): 1229-33, 2015. 24- Ohne H.: Keloid formation at the primary repair of cleft lip patients. Showa Uni J. Med. Sci., 46: 249, 1986. 25- Soltani A.M., Francis C.S., Motamed A., Karatsonyi A.L., Hammoudeh J.A., Sanchez-Lara P.A., et al.: Hypertrophic scarring in cleft lip repair: A comparison of incidence among ethnic groups. Clinical Epidemiology, 4: 187, 2012. 26- Chou P.Y., Luo C.C., Chen P.K., et al.: Preoperative lip measurement in patients with complete unilateral cleft lip/ palate and its comparison with norms. J. Plast. Reconstr. Aesthet. Surg., 66: 513-517, 2013.