Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: A preliminary study

Objective: To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM). Sample and Methods: Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T-1), before cheiloplasty (T-2), 1 month after cheiloplasty (T-3), and 1 year of age (T-4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella-nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side. Results: Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T-1 to T-4. The nostril height ratio was 0.5, 0.8, 1.09 and 0.9 for T-1 to T-4. The angle of the columella was 53.3 degrees, 69.9 degrees 91.2 degrees, and 86.9 degrees for T-1 to T-4. The average alveolar cleft width was 8.2 mm at T-1 and closed down to 2.4 mm before cheiloplasty (T-2) in cases with complete cleft. Conclusions: Infants with presurgical nasoalveolar molding improved symmetry of the nose in width, height, and columella angle, as compared to their presurgical status. There was some relapse of nostril shape in width (10%), height (20%), and angle of columella (4.7%) at 1 year of age.