Moshal T, Roohani I, Jolibois M, Lasky S, Manasyan A, Naidu P, Munabi N C O, Urata M M, Hammoudeh J A, Magee W P
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Cleft Palate Craniofac J. 2024 Dec 12:10556656241286386. doi: 10.1177/10556656241286386.
Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP).
Systematic Review and Meta Analysis.
Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded.
Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM.
Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001).
This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.
鼻牙槽骨塑形（NAM）可优化唇腭裂（CLP）患者的美学效果，尤其是对于裂隙较宽的患者。然而，其对诸如面中部发育不全（MFH）等长期术后后遗症的影响仍不明确。本研究分析了头影测量数据，以评估NAM对完全性单侧唇腭裂（UCLP）患者MFH的影响。
系统评价与荟萃分析。
纳入的研究报告了年龄≥7岁、接受过手术修复的UCLP患者的头影测量数据，这些患者接受了术前NAM治疗与未接受NAM治疗（对照）。排除双侧病例或未手术腭裂的研究。
主要观察指标为接受NAM治疗与未接受NAM治疗患者的头影测量角度（蝶鞍-鼻根-A点（SNA）、蝶鞍-鼻根-B点（SNB）和A点-鼻根-B点（ANB））。
在2063篇文章中，3篇符合纳入标准。报告了171例患者（89例接受NAM治疗，82例未接受NAM治疗）的头影测量数据，平均年龄为8.5±0.9岁。汇总分析显示，与未接受NAM治疗的队列相比，接受NAM治疗的队列的SNA（78.8°±1.5°对76.7°±1.5°，p = 0.169）、SNB（75.5°±1.0°对75.5°±1.0°，p = 0.954）和ANB（3.6°±1.4°对1.23°±1.2°，p = 0.089）角度差异无统计学意义。荟萃分析显示，与未接受NAM治疗的队列相比，接受NAM治疗的队列的SNA（平均差（MD）-1.96 [-3.31至-0.61]，p = 0.005）和ANB角度（MD -2.22 [-3.20至-1.24]，p < 0.001）显著更小。
这项荟萃分析表明，接受术前NAM治疗的UCLP患者的SNA和ANB角度显著更小，这可能表明MFH更严重。在选择NAM之前，临床医生应考虑CLP的严重程度、潜在的矢状面生长受限情况以及可行性，尤其是在资源匮乏的环境中。
