PURPOSE: Nasoalveolar molding (NAM) repositions the alveolar segments, medializes the alar base, and lengthens the columella, allowing for more favorable anatomic relationships for subsequent surgical cleft lip repair. Anthropometry and two-dimensional (2D) facial photography have been classically used to assess the resulting morphologic changes. As the changes occur in three dimensions (3D), 3D photography (stereophotogrammetry) may be better suited to assess patients’ skeletal and soft tissue positions, but there is a relative paucity of data in the available literature. We aimed to address this by using stereophotogrammetry to assess outcomes following NAM.
METHODS and MATERIALS: An Institutional Review Board (IRB) approved retrospective review was conducted to identify patients with unilateral cleft lips who underwent NAM. The Vectra three-dimensional (3D) imaging system (Canfield Scientific, Parsippany, NJ) captured 3D images before initiation and after completion of NAM. MeshLab (www.meshlab.net), an open-source software for processing, editing, and analyzing 3D triangular meshes, was used to perform quantitative analysis of the 3D photographs. Statistical analysis was performed with SPSS Version 24.0 (IBM Corp., Armonk, NY).
RESULTS: From 2015 to 2022, 21 patients with unilateral complete cleft lips who underwent NAM were identified. NAM was initiated at an average of 35.2 days of age (range, 8-98 days). Eleven (52.3%) patients were males and 13 (61.9%) had left-sided cleft lips. Patients wore NAM devices for an average of 103.5 days (range, 70-173 days). Following NAM treatment, patients had decreased cleft width (p=0.005) as well as reduced deviation of the subnasale (p<0.001) and nasal tip (p<0.001).
CONCLUSIONS: Nasoalveolar molding achieves structural changes presurgically, optimizing patients for surgical cleft lip repair. Facial stereophotogrammetry is a feasible option to quantify post-NAM morphologic changes. It is noninvasive, non-ionizing, inexpensive, and captures images quickly, therefore making it well-suited for use with pediatric patients. In addition, the 3D images can be analyzed with freely accessible, open-source software.