Efficacy of Postsurgical Nostril Retainer in Patients with Unilateral Cleft Lip and Palate Treated with Presurgical Nasoalveolar Molding and Primary Cheiloplasty-Rhinoplasty

Overview

The study asked whether nasal shape in infants with a one sided cleft lip and palate differs when a nostril retainer is worn after surgery. All patients had presurgical nasoalveolar molding, a device shaping the nose and gum before the operation, followed by primary lip and nose surgery. This review compared 50 consecutive non syndromic patients.

Sections of note

• Retrospective cross sectional review; 50 patients, 24 with a retainer and 26 without; level of evidence III.
• Nasal impressions were taken at an average age of 12 months and 6 days.
• Six measurements were recorded on both sides: alar width at maximum convexity, total alar base width, tip projection, columella length, and nostril aperture width and height.
• Comparisons were made between cleft and non cleft sides within each group and between groups.
• Cleft side nasal dimensions were significantly better in the retainer group across all measures except nasal projection, P less than 0.05.
• The retainer group showed less difference between the cleft and non cleft sides in all six measurements, P less than 0.05.
• The authors conclude nasal shape at 12 months was better with a postsurgical retainer.

What it means for a patient

• A nostril retainer is a soft device worn inside the nostril after surgery to hold its shape while healing.
• Wearing one was associated with a more symmetric nose at one year of age.
• Tip projection was the one measure that did not differ.
• This is a retrospective comparison, not a randomized trial, so families who used the retainer may differ in other ways.

Why this paper matters

Cleft nasal deformity tends to recur as scar contracts after infant surgery, and retainers are used to counter that without strong evidence. This study measures physical outcomes at one year. Whether the advantage persists as the child grows is not addressed.

Terms

• Unilateral cleft lip and palate: a cleft affecting one side of the lip and the roof of the mouth.
• Nasoalveolar molding: a device worn before surgery to shape the nose and gum ridge.
• Nostril retainer: a soft insert worn after surgery to hold the nostril shape.
• Cheiloplasty: surgical repair of the lip.
• Alar base width: the distance across the outer edges of the nostrils.
• Columella: the strip of tissue between the two nostrils.