Comparative outcomes of two nasoalveolar molding techniques for bilateral cleft nose deformity

Background: Bilateral cleft nose deformity is increasingly being treated before primary repair with nasoalveolar molding. With the Grayson technique, nasal molding is started when the alveolar gap is reduced to 5 mm, whereas with the Figueroa technique, nasal molding and alveolar molding are performed at the same time. Both techniques significantly lengthen the columella, but their comparative efficacy, efficiency, and incidence of complications have not been investigated. Methods: In this blinded, retrospective study of 58 patients with complete bilateral cleft lip-cleft palate, 27 underwent Grayson nasoalveolar molding and 31 underwent Figueroa nasoalveolar molding. Outcomes were compared by analyzing pretreatment and posttreatment facial photographs and clinical charts for efficacy (i.e., columella length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, and nasal base angle), efficiency (i.e., molding frequency), and incidence of complications (e.g., facial irritation and oral mucosal ulceration). Results: Grayson and Figueroa nasoalveolar molding did not differ in treatment efficacy for columellar length ratio, alar width ratio, alar base width ratio, nostril shape, nasal tip angle, nasolabial angle, or nasal base angle (all p > 0.05). Grayson nasoalveolar molding was less efficient (i.e., required more adjustments) (10.8 ± 4.1 versus 7.6 ± 1.5; p = 0.001) and had a higher incidence of oral mucosal ulceration (26 percent versus 3 percent; p < 0.05). Conclusions: Both Grayson and Figueroa nasoalveolar molding similarly improve nasal deformities and reduce alveolar gaps; however, the Figueroa technique is associated with fewer oral mucosal complications and more efficiency.