Grayson's Technique for Presurgical Nasoalveolar Molding (PNAM) in Unilateral Cleft Lip and Palate: A Systematic Review and Single-Arm Meta-Analysis.
Laith Bayan, Emma Nordahl, Kelson Huynh et al.
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In 30 seconds
This systematic review and single-arm meta-analysis assessed Grayson-protocol presurgical nasoalveolar molding (PNAM) in infants with unilateral cleft lip and palate. It included 21 studies reporting 534 infants, 368 of whom received PNAM. Pooled results showed improved nasal symmetry and a narrower alveolar gap: nostril width ratio decreased from 2.4 (95% CI, 1.7-3.1; I² = 98%) to 1.8 (95% CI, 0.9-2.6; I² = 97%), while the alveolar gap decreased from 10.7 mm (95% CI, 9.5-11.9; I² = 92%) to 3.9 mm (95% CI, 3.1-4.8; I² = 93%).
Key findings
- Nostril width ratio decreased from 2.4 (95% CI, 1.7-3.1; I² = 98%) to 1.8 (95% CI, 0.9-2.6; I² = 97%).
- Columellar angle increased from 52° (95% CI, 42.0-62.8; I² = 100%) to 70° (95% CI, 59.1-80.6; I² = 98%).
- Alveolar gap narrowed from 10.7 mm (95% CI, 9.5-11.9; I² = 92%) to 3.9 mm (95% CI, 3.1-4.8; I² = 93%).
- Intertuberosity distance increased slightly, from 31.3 mm (95% CI, 29.3-33.3; I² = 95%) to 31.8 mm (95% CI, 28.9-34.8; I² = 98%).
Why it matters
PNAM is intended to modify nasal and alveolar morphology before definitive surgery. The pooled findings suggest measurable changes in both areas, which may inform understanding of presurgical preparation in infants with unilateral cleft lip and palate. However, substantial heterogeneity across outcomes and the need for standardized measures and long-term prospective studies temper confidence in the estimates.
What to keep in mind
The review reports very high heterogeneity across pooled outcomes. The authors call for standardized outcome measures and long-term prospective studies to confirm findings and refine protocols.