Surgeon's and Caregivers' Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

A Prospective Multicenter Pilot Study

Hillary Broder, Roberto L. Flores, Sean Clouston, Richard E. Kirschner, Judah S. Garfinkle, Lacey Sischo, Ceib Phillips

Research output: Contribution to journalArticle

Abstract

Background: Despite the increasing use of nasoalveolar molding in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without nasoalveolar molding in a nonrandomized, prospective, multicenter study. Methods: Participants were 110 infants with cleft lip/palate (62 treated with and 48 treated without nasoalveolar molding) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photographs for a randomized subset of 54 infants were rated before treatment and after surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photographs included frontal, basal, left, and right views of the infants. Using the same scale, caregivers rated their infants' lip, nose, and facial appearance compared with the general population of infants without clefts before treatment and after surgery. Multilevel modeling was used to model change in ratings of infants' appearance before treatment and after surgery. Results: The expert clinician ratings indicated that nasoalveolar molding-treated infants had more severe clefts before treatment, yet both groups were rated equally after surgery. Nasoalveolar molding caregivers reported better postsurgery outcomes compared with no-nasoalveolar molding caregivers (p <0.05), particularly in relation to the appearance of the nose. Conclusions: Despite having a more severe cleft before treatment, infants who underwent nasoalveolar molding were found by clinician ratings to have results comparable to those who underwent lip repair alone. Infants who underwent nasoalveolar molding were perceived by caregivers to have better treatment outcomes than those who underwent lip repair without nasoalveolar molding.

Original languageEnglish (US)
Pages (from-to)938-945
Number of pages8
JournalPlastic and Reconstructive Surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Cleft Lip
Caregivers
Multicenter Studies
Lip
Nose
Therapeutics
Surgeons
Cleft Palate
Prospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Surgeon's and Caregivers' Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding : A Prospective Multicenter Pilot Study. / Broder, Hillary; Flores, Roberto L.; Clouston, Sean; Kirschner, Richard E.; Garfinkle, Judah S.; Sischo, Lacey; Phillips, Ceib.

In: Plastic and Reconstructive Surgery, Vol. 137, No. 3, 01.03.2016, p. 938-945.

Research output: Contribution to journalArticle

Broder, Hillary ; Flores, Roberto L. ; Clouston, Sean ; Kirschner, Richard E. ; Garfinkle, Judah S. ; Sischo, Lacey ; Phillips, Ceib. / Surgeon's and Caregivers' Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding : A Prospective Multicenter Pilot Study. In: Plastic and Reconstructive Surgery. 2016 ; Vol. 137, No. 3. pp. 938-945.
@article{695ab7c2c6c94c2f918b9fc74b876707,
title = "Surgeon's and Caregivers' Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding: A Prospective Multicenter Pilot Study",
abstract = "Background: Despite the increasing use of nasoalveolar molding in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without nasoalveolar molding in a nonrandomized, prospective, multicenter study. Methods: Participants were 110 infants with cleft lip/palate (62 treated with and 48 treated without nasoalveolar molding) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photographs for a randomized subset of 54 infants were rated before treatment and after surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photographs included frontal, basal, left, and right views of the infants. Using the same scale, caregivers rated their infants' lip, nose, and facial appearance compared with the general population of infants without clefts before treatment and after surgery. Multilevel modeling was used to model change in ratings of infants' appearance before treatment and after surgery. Results: The expert clinician ratings indicated that nasoalveolar molding-treated infants had more severe clefts before treatment, yet both groups were rated equally after surgery. Nasoalveolar molding caregivers reported better postsurgery outcomes compared with no-nasoalveolar molding caregivers (p <0.05), particularly in relation to the appearance of the nose. Conclusions: Despite having a more severe cleft before treatment, infants who underwent nasoalveolar molding were found by clinician ratings to have results comparable to those who underwent lip repair alone. Infants who underwent nasoalveolar molding were perceived by caregivers to have better treatment outcomes than those who underwent lip repair without nasoalveolar molding.",
author = "Hillary Broder and Flores, {Roberto L.} and Sean Clouston and Kirschner, {Richard E.} and Garfinkle, {Judah S.} and Lacey Sischo and Ceib Phillips",
year = "2016",
month = "3",
day = "1",
doi = "10.1097/01.prs.0000479979.83169.57",
language = "English (US)",
volume = "137",
pages = "938--945",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Surgeon's and Caregivers' Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding

T2 - A Prospective Multicenter Pilot Study

AU - Broder, Hillary

AU - Flores, Roberto L.

AU - Clouston, Sean

AU - Kirschner, Richard E.

AU - Garfinkle, Judah S.

AU - Sischo, Lacey

AU - Phillips, Ceib

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Despite the increasing use of nasoalveolar molding in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without nasoalveolar molding in a nonrandomized, prospective, multicenter study. Methods: Participants were 110 infants with cleft lip/palate (62 treated with and 48 treated without nasoalveolar molding) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photographs for a randomized subset of 54 infants were rated before treatment and after surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photographs included frontal, basal, left, and right views of the infants. Using the same scale, caregivers rated their infants' lip, nose, and facial appearance compared with the general population of infants without clefts before treatment and after surgery. Multilevel modeling was used to model change in ratings of infants' appearance before treatment and after surgery. Results: The expert clinician ratings indicated that nasoalveolar molding-treated infants had more severe clefts before treatment, yet both groups were rated equally after surgery. Nasoalveolar molding caregivers reported better postsurgery outcomes compared with no-nasoalveolar molding caregivers (p <0.05), particularly in relation to the appearance of the nose. Conclusions: Despite having a more severe cleft before treatment, infants who underwent nasoalveolar molding were found by clinician ratings to have results comparable to those who underwent lip repair alone. Infants who underwent nasoalveolar molding were perceived by caregivers to have better treatment outcomes than those who underwent lip repair without nasoalveolar molding.

AB - Background: Despite the increasing use of nasoalveolar molding in early cleft treatment, questions remain about its effectiveness. This study examines clinician and caregiver appraisals of primary cleft lip and nasal reconstruction with and without nasoalveolar molding in a nonrandomized, prospective, multicenter study. Methods: Participants were 110 infants with cleft lip/palate (62 treated with and 48 treated without nasoalveolar molding) and their caregivers seeking treatment at one of six high-volume cleft centers. Using the Extent of Difference Scale, standard photographs for a randomized subset of 54 infants were rated before treatment and after surgery by an expert clinician blinded to treatment group. Standard blocked and cropped photographs included frontal, basal, left, and right views of the infants. Using the same scale, caregivers rated their infants' lip, nose, and facial appearance compared with the general population of infants without clefts before treatment and after surgery. Multilevel modeling was used to model change in ratings of infants' appearance before treatment and after surgery. Results: The expert clinician ratings indicated that nasoalveolar molding-treated infants had more severe clefts before treatment, yet both groups were rated equally after surgery. Nasoalveolar molding caregivers reported better postsurgery outcomes compared with no-nasoalveolar molding caregivers (p <0.05), particularly in relation to the appearance of the nose. Conclusions: Despite having a more severe cleft before treatment, infants who underwent nasoalveolar molding were found by clinician ratings to have results comparable to those who underwent lip repair alone. Infants who underwent nasoalveolar molding were perceived by caregivers to have better treatment outcomes than those who underwent lip repair without nasoalveolar molding.

UR - http://www.scopus.com/inward/record.url?scp=84959432472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959432472&partnerID=8YFLogxK

U2 - 10.1097/01.prs.0000479979.83169.57

DO - 10.1097/01.prs.0000479979.83169.57

M3 - Article

VL - 137

SP - 938

EP - 945

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 3

ER -