Experience with presurgical nasal molding in infants with cleft lip and nose deformity.

BACKGROUND: Nasal deformity in infants with nasolabial clefts persists if it is not actively corrected. Some surgeons repair the nose simultaneously with the lip. Nonsurgical nasal molding with mechanical support performed in the early neonatal period has proved to be an effective alternative to surgical correction.
METHODS: At the author's institution, for the past 4 years, infants with nasal asymmetry have been treated by presurgical nasal molding performed with a stent fixed to a conventional passive orthopedic plate. The efficiency of this method was evaluated retrospectively using photographs obtained at least 1 year after lip repair. Sixteen pairs of children were studied. One child of each pair had received the treatment with the stent, and the other one had been treated using the classic method of presurgical orthopedics with no stent; the diagnosis and remaining therapy were the same for both children. Nine maxillofacial surgeons and 22 students of dental medicine were asked to decide which nose of each pair was more symmetrical.
RESULTS: Seventy-five percent of students and 70 percent of surgeons found that the nasal stent nose was more symmetrical than its classically treated counterpart. Statistical analysis of the results revealed highly significant agreement between the two groups of evaluators.
CONCLUSIONS: Children who underwent presurgical treatment with a nasal stent had more symmetrical noses several years after lip repair than children treated by the classic method of preoperative orthopedics. Use of the modified appliance did not present major problems for the parents, but their cooperation is necessary. Treatment should start as soon as possible after birth, regardless of the width of the cleft.