Study Examines How Sociodemographic Factors May Affect Success of NAM Treatment

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Cover image for the March issue of The Cleft Palate-Craniofacial Journal
  • Older fathers, younger mothers, married couples achieved more successful outcomes
  • Study results may help identify families in need of additional support, alternative treatment options

CHAPEL HILL, N.C. March 9, 2021–Older fathers, younger mothers, and married couples achieved more successful outcomes for their children with cleft lip/palate (CL/P) during nasoalveolar molding (NAM) treatment, according to a recent study. The results were published in the March 2021 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“Understanding the multiple factors that impact the outcome of NAM is critical to improving our patient care. This study contributes to the literature by examining the sociodemographic predictors and identifying factors that might make some groups of patients and families more successful than others. As suggested by the authors, these insights allow us to consider how we can target our approaches in the use of NAM to optimize care for all families,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

NAM is a presurgical infant orthopedic treatment protocol designed to limit the number of surgical interventions for children with CL/P. It is performed during the first three to five months after birth and has been demonstrated to improve objective measures of nasal symmetry and morphology, subjective nasal aesthetics, and nearly eliminate the need for surgical nasal revisions in unilateral CL/P.

“A child’s caregivers are responsible for the daily insertion, removal, cleaning and taping of the NAM appliance, and there is concern among clinicians that this commitment may place too great a burden on families,” according to Travis L. Gibson, DMD, lead researcher. “In this study, we wanted to assess the influence of social and demographic factors such as family composition, language, and insurance coverage on the completion, success, and difficulty of NAM treatment.”

One hundred and six patients were included in the study: 79 with unilateral involvement, and 27 with bilateral. A review of medical and social history forms yielded the following social and demographic data for each child: parental marital status, parental ages, number of siblings, linear distance from home to treatment center, insurance coverage, concurrent medical conditions or syndromes, and the need for an interpreter. Three categories of treatment outcomes were defined and assessed: completion, success, and difficulty.

Of the 106 patients, 104 successfully completed NAM therapy, meaning treatment was continuous until the day of surgical repair. Paternal and maternal age, and marital status were found to be key contributing factors with regard to successful NAM treatment and achieving significant alveolar cleft gap closure.

“Due to the significant time and effort required by parents to perform NAM, it may be that the dynamics of families with the more successful outcomes had more adults available to share the NAM responsibilities,” Gibson said. “Going forward, it may be beneficial to identify families more likely to have difficulty with NAM so that additional support can be offered, or alternative treatments can be recommended.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit acpa-cpf.org.

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit acpa-cpf.org.