SP36. Surgeons’ Perception on Nasoalveolar Molding Therapy in Cleft Lip and/or Palate Patients

PURPOSE: Nasoalveolar molding (NAM) is a pre-surgical intervention designed to bring the palatal shelves into closer opposition and realign the soft tissue and cartilaginous tissues of the lip and nose in infants born with cleft lip and/or palate. Current literature reports that NAM provides significant improvement in soft-tissue morphology pre-surgically, and can aid surgeons in improving surgical outcomes, leading to a reduction in post-surgical follow-up visits and revision surgery (Rubin 2015). The present study assesses cleft surgeons’ perception of cleft severity, predicted quality of outcomes, and the likelihood of revision surgery before and after NAM therapy.. METHODS: A REDCap survey was distributed to cleft surgeons in June 2024. The survey included 12 patient profiles containing 6 profiles before and 6 profiles after NAM therapy. These profiles were randomized to prevent bias, and each profile was accompanied by a total of 9 questions, three questions each on the severity of the defect, predicted quality of outcomes, and likelihood of revision surgery. Each question was answered on a 5-point Likert scale with lower scores corresponding to better outcomes. For instance, 1 indicated minimal severity, very good quality of surgical outcome, and extremely unlikely to require revision surgery. Survey responses for patient profiles before and after NAM-therapy were paired, and differences were compared using Wilcoxon signed-rank tests for each survey question. RESULTS: Out of 151 surgeon participants, 65 surgeons (43%) completed all 12 patient profiles. A total of 780 paired completed patient profiles were included for analysis. Patients after NAM therapy were rated as having significantly less severe nasal (3.0 vs. 2.6, P < 0.001), columella (3.0 vs. 2.5, P < 0.001), and lip deformity (3.1 vs. 2.6, P < 0.001) than those before NAM therapy. Patients after NAM therapy were also perceived to have a higher quality expected outcome following primary repair of their nasal (2.5 vs. 2.1, P < 0.001), columella (2.6 vs. 2.1, P < 0.001), and lip deformity (2.3 vs. 1.9, P < 0.001) than those before NAM therapy. Finally, patients who had undergone NAM therapy were rated to have a less likelihood of requiring nasal (2.6 vs. 2.3, P < 0.001), columella (2.6 vs. 2.2, P < 0.001), and lip revision surgery (2.6 vs. 2.2, P < 0.001) before entering school (5-6 years old). CONCLUSION: Cleft surgeons perceive patients who have undergone NAM therapy to have less severe defects, a higher likelihood of a good surgical outcome, and a lower likelihood of requiring revision surgeries. This study underscores the benefits of NAM therapy in achieving more favorable aesthetic and functional outcomes for patients and families.