Comparative clinical evaluation of modified and conventional Grayson’s presurgical nasoalveolar molding technique in infants with complete unilateral cleft lip and palate

Abstract

Background: Presurgical nasoalveolar molding (PNAM) was introduced by Grayson et al., in
1993 to presurgically mold the alveolus, lip, and nose in infants with cleft lip and palate (CLP). The
aim of this comparative clinical trial was to evaluate the efficacy and efficiency of Modified and
Conventional Grayson’s PNAM in patients concerning morphological and anatomical changes in
maxillary alveolus, nasal symmetry, number of visits, and duration of treatment.
Materials and Methods: In this comparative clinical trial study, 16 infants with unilateral complete
CLP were equally divided into two groups: Group I (modified PNAM technique using titanium
molybdenum alloy [TMA] wire nasal stent) and Group II (conventional PNAM technique using
stainless steel wire nasal stent). Patient photographic evaluation of nasal symmetry and maxillary
study model CAD‑CAM analysis, pre‑ and post‑operatively in both groups, were compared using a
paired t‑test between the groups using the Chi‑square test with P < 0.05 as statistically significant.
Results: In both groups, on evaluating nasal measurements, statistically significant (P < 0.05) decrease
in nasal width and increase in columella deviation angle, a decrease of nostril length, and an increase
of columella length in Group I were observed. On maxillary study model evaluation, a statistically
significant (P < 0.05) decrease in width of the alveolar cleft was noticed in both groups and lateral
deviation of the incisal point in Group I and width of the palatal cleft in Group II was noticed.
Conclusion: This study showed a morphological improvement in nasal symmetry and maxillary
alveolar morphology in complete unilateral CLP patients, treated with both Modified and
Conventional PNAM techniques, with the Modified PNAM technique being more efficient for
treatment duration and the number of adjustments as there are less number of visits.
Key Words: Cleft lip, cleft palate, nasal, titanium molybdenum alloy, unilateral