Taoyuan, Linkou, and Taipei, Taiwan From the Craniofacial Center and the Craniofacial Research Center, Chang Gung Memorial Hospital; the College of Medicine, Chang Gung University; the Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital; the Department of Craniofacial Orthodontics; and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.
Plast Reconstr Surg. 2012 Dec;130(6):1289-1295. doi: 10.1097/PRS.0b013e31826d16f3.
Nasoalveolar molding is increasingly being used to treat unilateral cleft nose deformity before primary repair. The Grayson technique starts nasal molding when an alveolar gap is reduced to 5 mm, whereas the Figueroa technique performs nasal and alveolar molding at the same time. The authors investigated the comparative efficacy, efficiency, and incidence of complications of the two techniques.
A blinded, retrospective study was conducted on 63 patients with complete unilateral cleft lip-cleft palate; 31 underwent the Grayson nasoalveolar molding and 32 underwent the Figueroa nasoalveolar molding. Pretreatment and posttreatment facial photographs and clinical charts were used to compare efficacy (nostril height ratio, nostril width ratio, columellar angle), efficiency (molding frequency), and incidence of complications (facial irritation, mucosal ulceration).
The Grayson and Figueroa techniques did not differ in treatment efficacy for nostril height ratio (0.86 ± 0.09 versus 0.85 ± 0.09; p > 0.05) and columellar angle (84.0 ± 4.5 degrees versus 85.3 ± 2.6 degrees; p > 0.05). Although the Grayson technique was more effective for reducing nostril width ratio (1.21 ± 0.29 versus 1.27 ± 0.19, p = 0.05), it was less efficient (i.e., required more adjustments) (10.9 ± 2.5 versus 8.8 ± 1.9; p < 0.001) and had a higher incidence of mucosal ulceration (23 percent versus 3 percent; p < 0.05).
The two nasoalveolar molding techniques differed in efficacy, efficiency, and incidence of complications in patients with complete unilateral cleft lip-cleft and palate. Understanding these differences may help surgeons and orthodontists improve outcome expectations and consultations with patients' families.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
鼻牙槽塑形术越来越多地用于在初次修复前治疗单侧唇腭裂的鼻畸形。Grayson 技术在牙槽间隙缩小至 5mm 时开始进行鼻塑形，而 Figueroa 技术则同时进行鼻和牙槽塑形。作者研究了两种技术的比较疗效、效率和并发症发生率。
对 63 例完全单侧唇腭裂患者进行了一项盲法、回顾性研究；其中 31 例接受了 Grayson 鼻牙槽塑形，32 例接受了 Figueroa 鼻牙槽塑形。使用治疗前和治疗后的面部照片和临床图表比较疗效（鼻孔高度比、鼻孔宽度比、鼻中隔角）、效率（塑形频率）和并发症发生率（面部刺激、粘膜溃疡）。
Grayson 和 Figueroa 技术在治疗鼻孔高度比（0.86±0.09 与 0.85±0.09；p>0.05）和鼻中隔角（84.0±4.5 度与 85.3±2.6 度；p>0.05）方面无差异。尽管 Grayson 技术在减小鼻孔宽度比方面更有效（1.21±0.29 与 1.27±0.19，p=0.05），但其效率较低（即需要更多调整）（10.9±2.5 与 8.8±1.9；p<0.001），且粘膜溃疡发生率较高（23%与 3%；p<0.05）。
两种鼻牙槽塑形技术在完全单侧唇腭裂患者中的疗效、效率和并发症发生率方面存在差异。了解这些差异可能有助于外科医生和正畸医生提高对结果的预期并与患者家属进行咨询。
临床问题/证据水平：治疗，III 级。
