Progressive changes of columella length and nasal growth after nasoalveolar molding in bilateral cleft patients: A 3-year follow-up study

BACKGROUND: The purpose of this study was to assess the progressive changes of columella length and nasal growth after presurgical nasoalveolar molding and primary cheiloplasty in bilateral complete cleft lip-cleft palate infants. METHODS: Twenty-two consecutive complete bilateral cleft lip-cleft palate infants were included. All of them underwent nasoalveolar molding for columella lengthening and retraction of the premaxilla for 3 to 4.5 months before primary cheiloplasty. Standard 1:1 basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Nasal height and width were measured directly on the photographs. RESULTS: The results revealed that columella length was significantly lengthened after nasoalveolar molding and was further improved after primary cheiloplasty. The columella decreased in length slightly in the first and second years postoperatively and started to increase in length slightly in the third year postoperatively, whereas the rest of the nose grew significantly in height year by year. This consequently appeared as relapse of columella length. The shortage of the columella length was 1.9 mm. CONCLUSIONS: Both presurgical nasoalveolar molding and primary cheiloplasty lengthened the columella in bilateral cleft lip-cleft palate patients. However, there was a relative relapse in columella length because of the differential growth between the columella and the rest of the nose in the first and second years postoperatively.