Effectiveness of digitally- versus conventionally-fabricated nasoalveolar molding appliances for presurgical approximation of complete cleft lip and palate: A systematic review and meta-analysis of randomized controlled trials.
Aleksandra Velickovic, P Emile Rossouw, Fawad Javed
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In 30 seconds
This systematic review and meta-analysis compared digitally and conventionally fabricated nasoalveolar molding (NAM) appliances for presurgical cleft approximation in infants with complete cleft lip and palate. It included five randomized controlled trials, with 12–30 infants aged 5–45 days in the trials. Meta-analysis found no significant differences for several outcomes, including nostril height, cleft width, mid-arch width, and prolabial deviation. Digital appliances were associated with greater improvement in columella deviation and greater reduction in arch length (P<0.001), but the authors judged overall effectiveness debatable given limited, heterogeneous evidence.
Key findings
- Across five RCTs, no significant differences were found for nostril height, cleft width, mid-arch width, or prolabial deviation.
- Digital NAM was associated with greater improvement in columella deviation and greater reduction in arch length than conventional NAM (P<0.001).
- Risk of bias raised some concerns in four RCTs; certainty of evidence ranged from moderate to low.
Why it matters
NAM is used before surgery as part of comprehensive cleft lip and palate care, so evidence comparing fabrication approaches may inform assessment of presurgical outcomes. The review suggests possible advantages for selected measurements with digital appliances, but does not establish broad superiority. Interpreting these findings cautiously is important because the evidence base is small and heterogeneous.
What to keep in mind
Only five RCTs were included, with limited trial sample sizes and high heterogeneity. Certainty ranged from moderate to low, with imprecision and methodological limitations noted.