A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial.


Journal

Trials
ISSN: 1745-6215
Titre abrégé: Trials
Pays: England
ID NLM: 101263253

Informations de publication

Date de publication:
04 Jul 2024
Historique:
received: 25 05 2024
accepted: 04 06 2024
medline: 5 7 2024
pubmed: 5 7 2024
entrez: 4 7 2024
Statut: epublish

Résumé

Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

Sections du résumé

BACKGROUND BACKGROUND
Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment.
METHOD METHODS
The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site.
DISCUSSION CONCLUSIONS
We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe.
TRIAL REGISTRATION BACKGROUND
ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

Identifiants

pubmed: 38965585
doi: 10.1186/s13063-024-08229-z
pii: 10.1186/s13063-024-08229-z
doi:

Types de publication

Journal Article Clinical Trial Protocol

Langues

eng

Sous-ensembles de citation

IM

Pagination

453

Subventions

Organisme : The Wellcome Trust DBT India Alliance
ID : IA/CPHS/20/1/505255

Informations de copyright

© 2024. The Author(s).

Références

Vanderas AP. Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review. Cleft Palate J. 1987;24(3):216–25.
pubmed: 3308178
Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg. 2009;42(Suppl):S9–18.
doi: 10.4103/0970-0358.57182 pubmed: 19884687 pmcid: 2825065
Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999;36:486–98.
doi: 10.1597/1545-1569_1999_036_0486_pnmiiw_2.3.co_2 pubmed: 10574667
Barillas I, Dec W, Warren SM, Cutting CB, Grayson BH. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients. Plast Reconstr Surg. 2009;123:1002–6.
doi: 10.1097/PRS.0b013e318199f46e pubmed: 19319066
Ezzat CF, Chavarria C, Teichgraeber JF, Chen JW, Stratmann RG, Gateno J, Xia JJ. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J. 2007;44:8–12.
doi: 10.1597/06-009 pubmed: 17214541
Lee CT, Grayson BH, Cutting CB, Brecht LE, Lin WY. Prepubertal midface growth in unilateral cleft lip and palate following alveolar molding and gingivoperiosteoplasty. Cleft Palate Craniofac J. 2004;41:375–80.
doi: 10.1597/03-037.1 pubmed: 15297999
Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg. 1993;92(7):1422–3.
pubmed: 8248436
Shaw WC, Semb G, Nelson P, Brattstrom V, Molsted K, Prahl-Andersen B, Gundlach KK. The Eurocleft project 1996–2000: overview. J Craniomaxillofac Surg. 2001;29:131–40, discussion 141-132.
doi: 10.1054/jcms.2001.0217 pubmed: 11465251
Bearn D, Mildinhall S, Murphy T, Murray JJ, Sell D, Shaw WC, Williams AC, Sandy JR. Cleft lip and palate care in the United Kingdom–the Clinical Standards Advisory Group (CSAG) study. Part 4: outcome comparisons, training, and conclusions. Cleft Palate Craniofac J. 2001;38:38–43.
doi: 10.1597/1545-1569_2001_038_0038_clapci_2.0.co_2 pubmed: 11204680
Sandy J, Williams A, Mildinhall S, Murphy T, Bearn D, Shaw B, Sell D, Devlin B, Murray J. The Clinical Standards Advisory Group (CSAG) cleft lip and palate study. Br J Orthod. 1998;25:21–30.
doi: 10.1093/ortho/25.1.21 pubmed: 9547971
Sandy JR, Williams AC, Bearn D, Mildinhall S, Murphy T, Sell D, Murray JJ, Shaw WC. Cleft lip and palate care in the United Kingdom–the Clinical Standards Advisory Group (CSAG) study. Part 1: background and methodology. Cleft Palate Craniofac J. 2001;38:20–3.
doi: 10.1597/1545-1569_2001_038_0020_clapci_2.0.co_2 pubmed: 11204677
Sischo L, Chan JW, Stein M, Smith C, van Aalst J, Broder HL. Nasoalveolar molding: prevalence of cleft centers offering NAM and who seeks it. Cleft Palate Craniofac J. 2012;49(3):270–5.
doi: 10.1597/11-053 pubmed: 21740168
Avinoam SP, Kowalski HR, Chaya BF, Shetye PR. Current presurgical infant orthopedics practices among American cleft palate association-approved cleft teams in North America. J Craniofac Surg. 2022;33:2522–8.
doi: 10.1097/SCS.0000000000008790 pubmed: 36409871
Batra P, Sybil D, Izhar A, Batra P, Thiruvenkatachari B. Standard of care for patients with cleft lip and palate in India—a questionnaire-based study. Cleft Palate Craniofac J. 2023;60:536–43.
doi: 10.1177/10556656221074212 pubmed: 35099313
Jaeger M, Braga-Silva J, Gehlen D, Sato Y, Zuker R, Fisher D. Correction of the alveolar gap and nostril deformity by presurgical passive orthodontia in the unilateral cleft lip. Ann Plast Surg. 2007;59:489–94.
doi: 10.1097/01.sap.0000259001.98869.d8 pubmed: 17992140
Maull DJ, Grayson BH, Cutting CB, Brecht LL, Bookstein FL, Khorrambadi D, Webb JA, Hurwitz DJ. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J. 1999;36:391–7.
doi: 10.1597/1545-1569_1999_036_0391_lteonm_2.3.co_2 pubmed: 10499400
Chou PY, Hallac RR, Ajiwe T, Xie XJ, Liao YF, Kane AA, Park YJ. The role of Nasoalveolar molding: a 3D Prospective analysis. Sci Rep. 2017;7:9901.
doi: 10.1038/s41598-017-10435-6 pubmed: 28852137 pmcid: 5575095
Kornbluth M, Campbell RE, Daskalogiannakis J, Ross EJ, Glick PH, Russell KA, Doucet JC, Hathaway RR, Long RE Jr, Sitzman TJ. Active presurgical infant orthopedics for unilateral cleft lip and palate: intercenter outcome comparison of Latham, modified McNeil, and nasoalveolar molding. Cleft Palate Craniofac J. 2018;55:639–48.
doi: 10.1177/1055665618757367 pubmed: 29461877 pmcid: 5903966
Levy-Bercowski D, Abreu A, DeLeon E, Looney S, Stockstill J, Weiler M, Santiago PE. Complications and solutions in presurgical nasoalveolar molding therapy. Cleft Palate Craniofac J. 2009;46:521–8.
doi: 10.1597/07-236.1 pubmed: 19929090
Clark SL, Teichgraeber JF, Fleshman RG, Shaw JD, Chavarria C, Kau CH, Gateno J, Xia JJ. Long-term treatment outcome of presurgical nasoalveolar molding in patients with unilateral cleft lip and palate. J Craniofac Surg. 2011;22:333–6.
doi: 10.1097/SCS.0b013e318200d874 pubmed: 21239929 pmcid: 4638318
Prahl C, Kuijpers-Jagtman AM, Van’t Hof MA, Prahl-Andersen B. A randomized prospective clinical trial of the effect of infant orthopedics in unilateral cleft lip and palate: prevention of collapse of the alveolar segments (Dutchcleft). Cleft Palate Craniofac J. 2003;40:337–42.
doi: 10.1597/1545-1569_2003_040_0337_arpcto_2.0.co_2 pubmed: 12846598
Prahl C, Kuijpers-Jagtman AM, van’t Hof MA, Prahl-Andersen B. A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci. 2001;109:297–305.
doi: 10.1034/j.1600-0722.2001.00056.x pubmed: 11695749
Rubin MS, Clouston SAP, Esenlik E, Shetye PR, Flores RL, Grayson BH. Midface growth in patients with unilateral cleft lip and palate treated with a nasoalveolar molding protocol. J Craniofac Surg. 2019;30:1640–3.
doi: 10.1097/SCS.0000000000005356 pubmed: 30950956
Papadopoulos MA, Koumpridou EN, Vakalis ML, Papageorgiou SN. Effectiveness of pre-surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta-analysis. Orthod Craniofac Res. 2012;15:207–36.
doi: 10.1111/j.1601-6343.2012.01552.x pubmed: 23020693
Asher-McDade C, Roberts C, Shaw WC, Gallager C. Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J. 1991;28:385–90.
doi: 10.1597/1545-1569_1991_028_0385_doamfr_2.3.co_2 pubmed: 1742308

Auteurs

Badri Thiruvenkatachari (B)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India. badri.t.chari@gmail.com.

Krishnamurthy Bonanthaya (K)

Bhagavan Mahaveer Jain Hospital, Bangalore, India.

Anne Marie Kuijpers Jagtman (AM)

Department of Orthodontics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland.

Jonathan Sandler (J)

Chesterfield Royal Hospital, Chesterfield Royal Hospital NHS Foundation Trust, Calow, England.

Rajesh S Powar (RS)

Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.

Syed Altaf Hussain (SA)

Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India.

B Subramaniyan (B)

Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India.

Nitin Bhola (N)

Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India.

Hari Kishore Bhat (HK)

Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India.

Varun Ramachandra (V)

Isha Hospital, Vadodara, Gurajat, India.

Sylvia Jayakumar (S)

John's Research Institute, Bangalore, India.

Puneet Batra (P)

Manav Rachna Dental College, Faridabad, Haryana, India.

Subhiksha Chakkaravarthi (S)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.

V Thailavathy (V)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.

Manoj Prathap (M)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.

Thulasiram Elumalai (T)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.

Karthika Nambiar (K)

Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.

Charanya Vijayakumar (C)

Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India.

Ravi Kumar Mahajan (RK)

Amandeep Hospital, Amritsar, Punjab, India.

Sundereshwer Chander Sood (SC)

Sant Parmanand Hospital, Delhi, India.

Sukhdeep Singh Kahlon (SS)

Amandeep Hospital, Amritsar, Punjab, India.

Shruti Bijapur (S)

Bhagavan Mahaveer Jain Hospital, Bangalore, India.

Ranjit Haridas Kamble (RH)

Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India.

K M Keluskar (KM)

Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India.

Amit Nilgar (A)

Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India.

Faizan Ahmed Khan (FA)

Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India.

Devika Das (D)

Isha Hospital, Vadodara, Gurajat, India.

Swetha Sridhar (S)

Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India.

Adrija Buch (A)

Isha Hospital, Vadodara, Gurajat, India.

Shuba Kumar (S)

Samarth, Chennai, India.

Rani Mohanraj (R)

Samarth, Chennai, India.

Stefan Listl (S)

Heidelberg University BIOMS: Universitat Heidelberg Bioquant, Heidelberg, Germany.

Samiksha Chopra (S)

Amandeep Hospital, Amritsar, Punjab, India.

Vikrant Jadhav (V)

Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India.

Anika Arora (A)

Manav Rachna Dental College, Faridabad, Haryana, India.

Chintan Valiya (C)

Isha Hospital, Vadodara, Gurajat, India.

Madhuri Pattamata (M)

Radboud Universiteit Nijmegen: Radboud Universiteit, Nijmegen, The Netherlands.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH