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Nasoalveolar molding use for cleft lip and palate reduces number of surgeries, cost of care

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IMAGE: Parit Patel, MD, is a plastic and reconstruction surgeon who specializes in craniofacial surgery and cleft conditions at Loyola University Health System.

Credit: Loyola University Health System

Patients with complete unilateral and bilateral cleft lip and palate (U/BCLP) who were treated with nasoalveolar molding (NAM) required fewer surgeries and a reduction in overall healthcare costs compared to similar patients who did not have NAM treatment, according to a study in The Journal of Craniofacial Surgery, authored by Parit A. Patel, MD.

Dr. Patel, an assistant professor at Loyola University Chicago Stritch School of Medicine, is a plastic and reconstruction surgeon who specializes in craniofacial surgery and cleft conditions at Loyola University Health System.

"NAM is a technique that molds the patient's lip, nose and gums decreasing the width of the cleft and contouring the nose before surgery is performed. This makes the surgery easier to perform and now has been shown to improve outcomes and reduce cost," says Dr. Patel, who has successfully implanted numerous patients with the device. "Surgery always has a certain element of risk and the use of NAM reduces complications and the overall number of surgeries. This results in a potentially healthier child, which is really the ultimate goal."

Cleft lip and palate are two of the most common major birth defects. They are usually diagnosed through a pregnancy ultrasound.

A cleft occurs when tissues of the face do not properly join together during development. The cause in most cases is unknown, however, risk factors include smoking during pregnancy, an older mother, obesity and certain medications such as some used to treat seizures. Cleft lip is more common in males while cleft palate is more common in females.

NAM is an oral plate similar to a retainer that is typically implanted in a baby's mouth four to five weeks after delivery. NAM helps to correct the deformity by reducing the size of the cleft before surgery is performed. Surgeries are required to permanently correct a cleft, but the study showed children with the NAM needed fewer surgeries.

Loyola is one of a few select academic medical centers offering NAM treatment to appropriate pediatric cleft patients. The Loyola plastic and reconstructive surgery team performs a full range of reconstructive and cosmetic surgical procedures and has subspecialty expertise in craniofacial surgery, hand surgery, microsurgery and complex wound care.

The article is titled, "Comparative Study of Early Secondary Nasal Revisions and Costs in Patients With Clefts Treated With and Without Nasoalveolar Molding." Authors are Parit A. Patel, MD, Marcie S. Rubin, DrPH, MPH, Sean Clouston, PhD, Frank Lalezaradeh, BS, Lawrence E. Brecht, DDS, Court B. Cutting, MD, Pradip R. Sheyte, DDS, MDS, Stephen M. Warren, MD, and Barry H. Grayson, DDS.

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Stasia Thompson
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