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Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM).

Publication ,  Journal Article
Dunworth, K; Porras Fimbres, D; Trotta, R; Hollins, A; Shammas, R; Allori, AC; Santiago, PE
Published in: Cleft Palate Craniofac J
April 2024

OBJECTIVE: 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. MAIN OUTCOME MEASURES: Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.

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Published In

Cleft Palate Craniofac J

DOI

EISSN

1545-1569

Publication Date

April 2024

Volume

61

Issue

4

Start / End Page

654 / 677

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Nose
  • Nasoalveolar Molding
  • Infant
  • Humans
  • Esthetics, Dental
  • Dentistry
  • Cleft Palate
  • Cleft Lip
  • Child
 

Citation

APA
Chicago
ICMJE
MLA
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Dunworth, K., Porras Fimbres, D., Trotta, R., Hollins, A., Shammas, R., Allori, A. C., & Santiago, P. E. (2024). Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J, 61(4), 654–677. https://doi.org/10.1177/10556656221136325
Dunworth, Kristina, Denisse Porras Fimbres, Rose Trotta, Andrew Hollins, Ronnie Shammas, Alexander C. Allori, and Pedro E. Santiago. “Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM).Cleft Palate Craniofac J 61, no. 4 (April 2024): 654–77. https://doi.org/10.1177/10556656221136325.
Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, et al. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J. 2024 Apr;61(4):654–77.
Dunworth, Kristina, et al. “Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM).Cleft Palate Craniofac J, vol. 61, no. 4, Apr. 2024, pp. 654–77. Pubmed, doi:10.1177/10556656221136325.
Dunworth K, Porras Fimbres D, Trotta R, Hollins A, Shammas R, Allori AC, Santiago PE. Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM). Cleft Palate Craniofac J. 2024 Apr;61(4):654–677.

Published In

Cleft Palate Craniofac J

DOI

EISSN

1545-1569

Publication Date

April 2024

Volume

61

Issue

4

Start / End Page

654 / 677

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Nose
  • Nasoalveolar Molding
  • Infant
  • Humans
  • Esthetics, Dental
  • Dentistry
  • Cleft Palate
  • Cleft Lip
  • Child