Duke University School of Medicine, Durham, NC, USA.
Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA.
Cleft Palate Craniofac J. 2024 Apr;61(4):654-677. doi: 10.1177/10556656221136325. Epub 2022 Nov 4.
To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO.
Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events.
MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools.
A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias.
Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.
批判性评价支持鼻牙槽塑形术（NAM）风险和疗效的科学文献，特别是与其他术前婴儿正畸（PSIO）方法或不进行 PSIO 治疗相比。
考虑了 5 个结果领域：鼻唇美学；牙牙槽关系；中面部生长；成本和护理负担；以及麻醉事件的数量。
从 Grayson-Santiago NAM 技术的首次描述（1993 年）到 2021 年 12 月 13 日，在 MEDLINE、Embase 和 Scopus 中查询文章。在应用包含和排除标准后，使用包括使用 Cochrane RoB 2.0 和 ROBINS-I 工具进行偏倚风险评估的系统框架对选定的文章进行批判性评价。
共纳入 88 项研究。I 级和 II 级证据表明，与其他 PSIO 相比，NAM 达到了同等或更好的切牙排列和牙槽对齐效果。II 级和 III 级证据表明，与其他 PSIO 相比，NAM 改善了鼻唇美学。II 级和 III 级证据支持 NAM 在 12 岁之前不会对颌面骨骼生长造成损害。少量 III 级证据支持 NAM 后唇或鼻的修订次数减少。II 级和 III 级证据表明，与某些替代方法相比，NAM 需要前期成本和频繁就诊，但减轻了照顾者的心理社会负担并降低了长期成本。许多研究存在高度偏倚风险。
当前的证据支持 NAM 在短期/中期结果方面的总体疗效，对中面部生长或牙齿发育产生负面影响的风险较低。许多论文中发现的高偏倚风险突出表明需要在未来的研究中进行稳健的研究设计。
