To identify demographic factors that influence choosing nasoalveolar molding (NAM) in the treatment of cleft lip with or without cleft palate (CL±P), and NAM treatment compliance.
Design:
This work is a retrospective cohort study.
Setting:
Tertiary pediatric hospital.
Patients, Participants:
One hundred forty-nine patients with a diagnosis of unilateral complete CL±P receiving treatment when NAM was offered (January 1, 2008-July 26, 2016).
Main Outcome Measure(s):
Demographic variables collected included race, ethnicity, ZIP code, number of caregivers, caregiver employment status, and health insurance status. Medical variables collected included diagnosis, treatment pursued, compliance with NAM, completion of NAM, and the treating cleft surgeon and orthodontist. Data were analyzed via Fisher exact tests, χ2 tests, and multivariate logistic regression to identify factors that influence the decision to pursue NAM and treatment compliance.
Results:
Univariate analyses identified the following significant factors predicting the pursuit of NAM: race and insurance type (both P < .001), surgeon (P = .005), income level (P = .009), comorbidities (P = .015), and syndromic diagnosis (P = .033). Driving distance trended toward significance (P = .078). Multivariate regression analyses indicated that Asian race (P = .047), insurance type (P = .046), driving distance (P = .019), and surgeon (P = .017) were significant predictors of pursuit of NAM.
Conclusions:
There are disparities in patient choice of NAM at our center for children with complete cleft lip. African American patient families were less likely to pursue this intervention. A stronger understanding of the barriers that lower income and minority patients face is needed in order to better characterize disparities in cleft care.
AbbottMMKokorowskiPJMearaJG. Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate. J Pediatr Surg. 2011;46(7):1319–1324. doi:10.1016/j.jpedsurg.2010.10.002
BellJCRaynes-GreenowCTurnerRBowerCDodsonANichollsWNassarN. School performance for children with cleft lip and palate: a population-based study. Child Care Health Dev. 2017;43(2):222–231. doi:10.1111/cch.12388
4.
BhopalR. Spectre of racism in health and health care: Lessons from history and the United States. BMJ. 1998;316(7149):1970–1973. doi:10.1136/bmj.316.7149.1970
5.
BradburyETHewisonJ. Early parental adjustment to visible congenital disfigurement. Child Care Health Dev. 1994;20(4):251–266.
6.
BroderHLWilson-GendersonMSischoL. Health disparities among children with cleft. Am J Public Health. 2012;102(5):828–830. doi:10.2105/AJPH.2012.300654
7.
BruneelLLuytenABettensKD'haeseleerEDhondtCHodgesAGaliwangoGVermeerschHVan LierdeK. Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate. J Commun Disord. 2017 September;69:1–14. doi:10.1016/j.jcomdis.2017.06.010
8.
ButaniYWeintraubJABarkerJC. Oral health-related cultural beliefs for four racial/ethnic groups: assessment of the literature. BMC Oral Health. 2008;8:26. doi:10.1186/1472-6831-8-26
9.
CanfieldMAMaiCTWangYO’HalloranAMarengoLOlneyRSBorgerCLRutkowskiRFornoffJIrwinN, et al.The association between race/ethnicity and major birth defects in the United States, 1999-2007. Am J Public Health. 2014;104(9):e14–e23. doi:10.2105/AJPH.2014.302098
10.
Correa de Queiroz HerkrathAPHerkrathFJBessa RebeloMAVettoreMV. Determinants of health-related and oral health-related quality of life in adults with orofacial clefts: a cross-sectional study. Cleft Palate Craniofac J. 2018;55(9):1244–1257. doi:10.1177/1055665618763377
11.
United States Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General (Executive Summary). National Institute of Dental and Craniofacial Research; 2000. Accessed October 22, 2018. https://www.nidcr.nih.gov/research/data-statistics/surgeon-general
12.
EsmondeNOGarfinkleJSChenYLambertWEKuangAA. Factors associated with adherence to nasoalveolar molding (NAM) by caregivers of infants born with cleft lip and palate. Cleft Palate Craniofac J. 2018;55(2):252–258. doi:10.1177/1055665617718550
13.
EzzatCFChavarriaCTeichgraeberJFChenWStratmannRGGatenoJXiaJJ. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2007;44(1):8–12. doi:10.1597/06-009
14.
FloresALIsenburgJHillardCLdeRossetLColenLBushTMaiC. Folic acid education for hispanic women: The promotora de salud model. J Womens Health. 2017 February;26(2):186–194. doi:10.1089/jwh.2016.6116
15.
FredrikssonAPontenEGordhTErikssonP. Neonatal exposure to a combination of N-methyl-D-aspartate and gamma-aminobutyric acid type A receptor anesthetic agents potentiates apoptotic neurodegeneration and persistent behavioral deficits. Anesthesiology. 2007;107(3):427–436. doi:10.1097/01.anes.0000278892.62305.9c
16.
FriedenTRCenters for Disease Control and Prevention (CDC). Forward: CDC health disparities and inequalities report—United States, 2011. MMWR Suppl. 2011;60(1):1–2. doi:su6001a1
17.
GarfinkleJSKingTWGraysonBHBrechtLECuttingCB. A 12-year anthropometric evaluation of the nose in bilateral cleft lip-cleft palate patients following nasoalveolar molding and cutting bilateral cleft lip and nose reconstruction. Plast Reconstr Surg. 2011;127(4):1659–1667. doi:10.1097/PRS.0b013e31820a64d7
18.
GraysonBHCuttingCB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J. 2001;38(3):193–198. doi:10.1597/1545-1569_2001_038_0193_pnomip_2.0.co_2
19.
GraysonBHGarfinkleJS. Early cleft management: the case for nasoalveolar molding. Am J Orthod Dentofacial Orthop. 2014;145(2):134–142. doi:10.1016/j.ajodo.2013.11.011
20.
GraysonBHMaullD. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate. Clin Plast Surg. 2004;31(2):58, vii. doi:10.1016/S0094-1298(03)00140-8
21.
GraysonBHSantiagoPEBrechtLECuttingCB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36(6):486–498. doi:10.1597/1545-1569_1999_036_0486_pnmiiw_2.3.co_2
22.
GraysonBHShetyePR. Presurgical nasoalveolar moulding treatment in cleft lip and palate patients. Indian J Plast Surg. 2009;42(suppl):56. doi:10.4103/0970-0358.57188
23.
GrollemundBGallianiESoupreVVazquezMPGuedeneyADanionA. The impact of cleft lip and palate on the parent-child relationships. Arch Pediatr. 2010;17(9):1380–1385. doi:10.1016/j.arcped.2010.06.026
24.
IngCHDiMaggioCJMalacovaEWhitehouseAJHegartyMKFengTBradyJEvon Ungern-SternbergBSDavidsonAJWallMM, et al.Comparative analysis of outcome measures used in examining neurodevelopmental effects of early childhood anesthesia exposure. Anesthesiology. 2014;120(6):1319–1332. doi:10.1097/ALN.0000000000000248
25.
JaegerMBraga-SilvaJGehlenDSatoYZukerRFisherD. Correction of the alveolar gap and nostril deformity by presurgical passive orthodontia in the unilateral cleft lip. Ann Plast Surg. 2007;59(5):489–494. doi:10.1097/01.sap.0000259001.98869.d8
26.
Jevtovic-TodorovicVHartmanREIzumiYBenshoffNDDikranianKZorumskiCFOlneyJWWozniakDF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–882. doi:23/3/876
27.
LeeCTGarfinkleJSWarrenSMBrechtLECuttingCBGraysonBH. Nasoalveolar molding improves appearance of children with bilateral cleft lip-cleft palate. Plast Reconstr Surg. 2008;122(4):1131–1137. doi:10.1097/PRS.0b013e318184590c
28.
Levy-BercowskiDAbreuADeLeonELooneySStockstillJWeilerMSantiagoPE. Complications and solutions in presurgical nasoalveolar molding therapy. Cleft Palate Craniofac J. 2009;46(5):521–528. doi:10.1597/07-236.1
29.
Lorot-MarchandAGuerreschiPPellerinPMartinotVGbaguidiCCNeivaCDevauchelleBFrochisseCPoli-MerolMLFrancois-FIquetC. Frequency and socio-psychological impact of taunting in school-age patients with cleft lip-palate surgical repair. Int J Pediatr Otorhinolaryngol. 2015;79(7):1041–1048. doi:10.1016/j.ijporl.2015.04.024
30.
MaillardSRetrouveyJMAhmedMKTaubPJ. Correlation between nasoalveolar molding and surgical, aesthetic, functional and socioeconomic outcomes following primary repair surgery: a systematic review. J Oral Maxillofac Res. 2017;8(3):e2. doi:10.5037/jomr.2017.8302
MatsuoKHiroseTOtagiriTNoroseN. Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period. Plast Reconstr Surg. 1989;83(1):25–31.
33.
MaullDJGraysonBHCuttingCBBrechtLLBooksteinFLKhorrambadiDWebbJAHurwitzDJ. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J. 1999;36(5):391–397. doi:10.1597/1545-1569_1999_036_0391_lteonm_2.3.co_2
Health disparities experienced by black or African Americans--United States Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2005January 14;54(1):1–3. PMID: 15647722
36.
National Research Council (US) Panel on DHHS Collection of Race and Ethnic Data. In: Ver PloegMPerrinE, eds. Eliminating Health Disparities: Measurement and Data Needs. National Academies Press; 2004. doi:NBK215751. Accessed October 22, 2018. https://www.ncbi.nlm.nih.gov/books/NBK215741/
37.
Nazarian MobinSSKaratsonyiAVidarENGamerSGroperJHammoudehJAUrataMM. Is presurgical nasoalveolar molding therapy more effective in unilateral or bilateral cleft lip-cleft palate patients?Plast Reconstr Surg. 2011;127(3):1263–1269. doi:10.1097/PRS.0b013e318205f3 ac
38.
PatelPARubinMSCloustonSLalezaradehFBrechtLECuttingCBShetyePRWarrenSMGraysonBH. Comparative study of early secondary nasal revisions and costs in patients with clefts treated with and without nasoalveolar molding. J Craniofac Surg. 2015;26(4):1229–1233. doi:10.1097/SCS.0000000000001729
39.
PatilPGPatilSPSarinS. Nasoalveolar molding and long-term postsurgical esthetics for unilateral cleft lip/palate: 5-year follow-up. J Prosthodont. 2011;20(7):577–582. doi:10.1111/j.1532-849X.2011.00782.x
40.
RappaportBASureshSHertzSEversASOrserBA. Anesthetic neurotoxicity—clinical implications of animal models. N Engl J Med. 2015;372(9):796–797. doi:10.1056/NEJMp1414786
41.
RubinMSCloustonSAhmedMMLoweKMShetyePRBroderHLWarrenSMGraysonBH. Assessment of presurgical clefts and predicted surgical outcome in patients treated with and without nasoalveolar molding. J Craniofac Surg. 2015;26(1):71–75. doi:10.1097/SCS.0000000000001233
42.
RuffRRCrerandCESischoLPeshanskyASarwerDBKirschnerREBroderHL. Surgical care for school-aged youth with cleft: results from a multicenter, prospective observational study. Cleft Palate Craniofac J. 2018:1055665618765776. doi:10.1177/1055665618765776
43.
SantiagoPEGraysonBHCuttingCBGianoutsosMPBrechtLEKwonSM. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty. Cleft Palate Craniofac J. 1998;35(1):77–80. doi:10.1597/1545-1569_1998_035_0077_rnfabg_2.3.co_2
44.
SasakiHTogashiSKarubeRYanagawaTNakaneSTabuchiKIshibashiNShinyaYItoHYamagataK, et al.Presurgical nasoalveolar molding orthopedic treatment improves the outcome of primary cheiloplasty of unilateral complete cleft lip and palate, as assessed by naris morphology and cleft gap. J Craniofac Surg. 2012;23(6):1596–1601. doi:10.1097/SCS.0b013e31825196 dc
45.
ShayPLGoldsteinJAPaligaJTWinkJJacksonOALowDBartlettSPTaylorJA. A comparative cost analysis of cleft lip adhesion and nasoalveolar molding before formal cleft lip repair. Plast Reconstr Surg. 2015;136(6):1264–1271. doi:10.1097/PRS.0b013e31829b69fe
46.
SischoLBroderHLPhillipsC. Coping with cleft: a conceptual framework of caregiver responses to nasoalveolar molding. Cleft Palate Craniofac J. 2015;52(6):640–650. doi:10.1597/14-113
47.
SischoLChanJWSteinMSmithCvan AalstJBroderHL. Nasoalveolar molding: prevalence of cleft centers offering NAM and who seeks it. Cleft Palate Craniofac J. 2012;49(3):270–275. doi:10.1597/11-053
48.
SischoLCloustonSAPhillipsCBroderHL. Caregiver responses to early cleft palate care: a mixed method approach. Health Psychol. 2016;35(5):474–482. doi:10.1037/hea0000262
49.
SunLSLiGMillerTLSalorioCByrneMWBellingerDCIngCParkRRadcliffeJHaysSR, et al.Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. 2016;315(21):2312–2320. doi:10.1001/jama.2016.6967
50.
TanakaSAMahabirRCJupiterDCMenezesJM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg. 2012;129(3):518e. doi:10.1097/PRS.0b013e3182402dd1
YangCHLaiJPLeeACChengLHHwangCF. Prognostic factors for hearing outcomes in children with Cleft Lip and Palate. Plast Reconstr Surg. 2019 February;143(2):368e–374e. PMID: 30688899. doi:10.1097/PRS.0000000000005219
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