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Original Research

Open Access

Influence of presurgical nasoalveolar molding (PNAM) treatment in maxillary dental arch width and nasolabial symmetry in patients with unilateral complete cleft lip and palate

  • Le Chang1,2,†
  • Qianqian Huang1,2,†
  • Zhanping Ren1,3,†
  • Yanhao Wang1,2
  • Yuhua Jiao1,2
  • Yongwei Tao1,3
  • Huaxiang Zhao1,2,*,
  • Yuxia Hou1,2,*,

1Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, 710004 Xi’an, Shaanxi, China

2Department of Orthodontics, College of Stomatology, Xi’an Jiaotong University, 710004 Xi’an, Shaanxi, China

3Department of Cleft Lip and Palate Surgery, College of Stomatology, Xi’an Jiaotong University, 710004 Xi’an, Shaanxi, China

DOI: 10.22514/jocpd.2023.090 Vol.47,Issue 6,November 2023 pp.155-162

Submitted: 07 March 2023 Accepted: 19 May 2023

Published: 03 November 2023

*Corresponding Author(s): Huaxiang Zhao E-mail:
*Corresponding Author(s): Yuxia Hou E-mail:

† These authors contributed equally.


Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subphenotypes among nonsyndromic cleft lip and/or palate (NSCL/P), that complicates surgical repair operations. Presurgical nasoalveolar molding (PNAM) is a technique used to reshape the nose, lip and alveolar bone of infants with UCCLP before surgery (the modified Mohler rotation advancement cheiloplasty and two flap palatoplasty), with the potential to facilitate surgical repair. However, the effectiveness of PNAM treatment is still a matter of debate. In this paper, the 3Shape scanning system and 3dMD stereophotography were used to assess the short-term and long-term effects of PNAM treatment on the dental arch morphology and nasolabial features of patients with UCCLP, respectively. The findings indicated that PNAM treatment negatively affects both short-term and long-term dental arch shape compared to the treatment without PNAM, particularly in terms of limiting the transverse width of the maxillary canine-to-midline. Regarding the nasal and labial symmetry, PNAM improves the symmetry of the nasal alae in patients over 7 years old and the symmetry of the lip in patients under 7 years old. Moreover, UCCLP patients who received PNAM treatment exhibited a shorter and wider shape of the nostril on the cleft side compared to those without PNAM treatment. In clinical practice, the multidisciplinary team should carefully consider the advantages and disadvantages of the outcomes of PNAM treatment when treating infants with cleft lip and palate.


Presurgical nasoalveolar molding; Cleft lip and palate; Unilateral complete cleft lip and palate; Dental arch morphology; Nasolabial features

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Le Chang,Qianqian Huang,Zhanping Ren,Yanhao Wang,Yuhua Jiao,Yongwei Tao,Huaxiang Zhao,Yuxia Hou. Influence of presurgical nasoalveolar molding (PNAM) treatment in maxillary dental arch width and nasolabial symmetry in patients with unilateral complete cleft lip and palate. Journal of Clinical Pediatric Dentistry. 2023. 47(6);155-162.


[1] Cooper ME, Ratay JS, Marazita ML. Asian oral-facial cleft birth prevalence. The Cleft Palate-Craniofacial Journal. 2006; 43: 580–589.

[2] Liu J, Zhang Y, Zhang L, Wang L, Jin L, D E Greene N, et al. Orofacial clefts in high prevalence area of birth defects—five counties, Shanxi province, China, 2000–2020. China CDC Weekly. 2021; 3: 773–777.

[3] Awotoye W, Mossey PA, Hetmanski JB, Gowans LJJ, Eshete MA, Adeyemo WL, et al. Whole-genome sequencing reveals de-novo mutations associated with nonsyndromic cleft lip/palate. Scientific Reports. 2022; 12: 11743.

[4] Tian T, Huang H, Wang W, Shi B, Zheng Q, Li C. Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate. BioMedical Engineering OnLine. 2022; 21: 31.

[5] Ferreira A, Da Costa G. Primary care in early cleft lip and palate rehabilitation: a dental perspective. Journal of Family Medicine and Primary Care. 2022; 11: 1212.

[6] Liou EJ, Subramanian M, Chen PKT, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plastic and Reconstructive Surgery. 2004; 114: 858-864.

[7] Burgaz MA, Cakan DG, Yılmaz RBN. Three-dimensional evaluation of alveolar changes induced by nasoalveolar molding in infants with unilateral cleft lip and palate: a case-control study. The Korean Journal of Orthodontics. 2019; 49: 286.

[8] Al Khateeb KA, Fotouh MA, Abdelsayed F, Fahim F. Short-term efficacy of presurgical vacuum formed nasoalveolar molding aligners on nose, lip, and maxillary arch morphology in infants with unilateral cleft lip and palate: a prospective clinical trial. The Cleft Palate-Craniofacial Journal. 2021; 58: 815–823.

[9] Kühlman DC, Almuzian M, Coppini C, Alzoubi EE. Accuracy (trueness and precision) of four tablet-based applications for three-dimensional facial scanning: an in-vitro study. Journal of Dentistry. 2023; 135: 104533.

[10] Kong L, Li Y, Liu Z. Digital versus conventional full-arch impressions in linear and 3D accuracy: a systematic review and meta-analysis of in vivo studies. Clinical Oral Investigations. 2022; 26: 5625–5642.

[11] Li Z, Giunta RE, Frank K, Schenck TL, Koban KC. Reproducibility of novel soft-tissue landmarks on three-dimensional human facial scan images in Caucasian and Asian. Aesthetic Plastic Surgery. 2022; 46: 719–731.

[12] Liu J, Zhang C, Cai R, Yao Y, Zhao Z, Liao W. Accuracy of 3-dimensional stereophotogrammetry: comparison of the 3dMD and Bellus3D facial scanning systems with one another and with direct anthropometry. American Journal of Orthodontics and Dentofacial Orthopedics. 2021; 160: 862–871.

[13] Bagante I, Zepa I, Akota I. 3D assessment of nasolabial appearance in patients with complete unilateral cleft lip and palate. The Cleft Palate-Craniofacial Journal. 2018; 55: 220–225.

[14] Kamble VD, Parkhedkar RD, Sarin SP, Patil PG, Kothari B. Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: a clinical report. Journal of Prosthodontic Research. 2013; 57: 224–231.

[15] Yin J, Zhang S, Huang N, Shi B, Zheng Q, Yang C. Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: a three-dimensional anthropometric study. Frontiers in Pediatrics. 2022; 10: 1101184.

[16] Clark SL, Teichgraeber JF, Fleshman RG, Shaw JD, Chavarria C, Kau C, et al. Long-term treatment outcome of presurgical nasoalveolar molding in patients with unilateral cleft lip and palate. Journal of Craniofacial Surgery. 2011; 22: 333–336.

[17] Chaisooktaksin N, Chimruang J, Worasakwutiphong S, Tansalarak R. Three-dimensional changes of maxillary alveolar morphology after using modified nasoalveolar molding in patients with complete unilateral cleft lip and palate. The Cleft Palate Craniofacial Journal. 2022. [Preprint].

[18] Generali C, Primozic J, Richmond S, Bizzarro M, Flores-Mir C, Ovsenik M, et al. Three-dimensional evaluation of the maxillary arch and palate in unilateral cleft lip and palate subjects using digital dental casts. European Journal of Orthodontics. 2017; 39: 641–645.

[19] Chang S, Lonic D, Pai BC, Lo L. Primary repair in patients with unilateral complete cleft of lip and primary palate. Annals of Plastic Surgery. 2018; 80: S2–S6.

[20] Al-Rudainy D, Ju X, Mehendale FV, Ayoub A. Longitudinal 3D assessment of facial asymmetry in unilateral cleft lip and palate. The Cleft Palate-Craniofacial Journal. 2019; 56: 495–501.

[21] Nayak T, Bonanthaya K, Parmar R, Shetty PN. Long-term comparison of the aesthetic outcomes between nasoalveolar molding- and non-nasoalveolar molding-treated patients with unilateral cleft lip and palate. Plastic & Reconstructive Surgery. 2021; 148: 775e–784e.

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