Three-dimensional evaluation of the nasolabial effects of nasoalveolar molding in unilateral cleft lip and palate patients

The aim of this prospective study was to evaluate three-dimensional nasolabial changes in infants with complete unilateral cleft lip and palate (CUCLP) treated by nasoalveolar molding (NAM) and compare to non-cleft controls. Thirty-nine CUCLP patients treated with NAM (mean age of 23.1±6.5 days) composed the study group. The control group comprised 10 healthy infants with a mean age of 23.7±6 days. Stereophotogrammetric records of the subjects in the study group were taken at pre-NAM (T0) and post-NAM (T1) whereas the control subjects' records were taken at a matching interval. Linear, angular and proportional measurements were carried on 3d stereophotogrammetric images using a software program. At T0, the cleft patients had significantly greater nostril and nasal widths, smaller nostril and columella heights, shorter philtrum on the cleft side, deviated columella and decreased nasal projection (p<0.001). Following NAM, on the cleft side, lip gap, nostril base width and diameter decreased (p<0.001), nostril height increased (p<0.001). Initially increased nostril height ratio significantly decreased with treatment (p<0.001). Inclination angle of the columella was steepened (p<0.001). Nasal projection angle significantly increased (p<0.01). Proportional measurements improved significantly in NAM group whereas in control group they remained the same. At T1, comparison of the study and control groups revealed that alar width, nasal base width and nostril diameter were greater (p<0.01, p<0.001 and p<0.001 respectively). Columella height was shorter on the cleft side compared to the controls (p<0.01). Nostril height and nasal projection angle did not differ between groups (p>0.05). The initial nasolabial cleft deformity of the CUCLP patients were significantly improved with NAM treatment. This improvement was mainly correlated with the severity of the initial deformity. Nasal projection and nostril height reached the normal values, whereas the transversal measurements were found to be larger despite the significant reduction. On the other hand, asymmetry of most of the nasolabial structures was improved following treatment. Key words: Complete unilateral cleft lip and palate, nasoalveolar molding, nasolabial changes, stereophotogrammetry, non-cleft control