Sociodemographic Predictors of Treatment Success and Difficulty in Nasoalveolar Molding

Abstract

Objective: To assess social and demographic influences on caregiver success and difficulty with nasoalveolar molding (NAM). Design: Retrospective review identified patients who began NAM between April 22, 2013, and April 18, 2017, at the New York University Langone Medical Center. Records were reviewed, and the following sociodemographic data retrieved: parental marital status, parental ages, number of siblings, distance traveled to clinic, insurance coverage, concurrent medical conditions, and need for an interpreter. Patients: Patients were included if complete charting was available; 106 patients met the inclusion criteria; 79 patients with unilateral and 27 with bilateral clefts. Outcome Measures: Chart entries indicating incorrect appliance usage, emergency visits, phone calls, and noncompliance were recorded. Alveolar cleft gap closure was measured on pre- and posttreatment models in unilateral cases. Multiple regression analyses were performed to assess the influence of social variables on these outcomes. Results: Alveolar cleft gap closure was 7.2 ± 3.0 mm, or 78.5% ± 19.1%. Cleft closure increased with paternal age by 0.33 mm ( P = .007) or 2.0% ( P = .017) per year, decreased with maternal age by 0.29 mm ( P = .041) per year, and increased in married and partnered parents by 39% ( P = .018). Incorrect appliance usage averaged 0.62 fewer instances for married and partnered parents ( P = .018) and 0.43 fewer for those with private insurance ( P = .019). Conclusions: Alveolar cleft gap closure was more successful for older fathers, younger mothers, and married couples. Married couples were also less likely to experience treatment difficulties such as incorrect appliance usage or inadequate duration of wear, as were those with private insurance coverage.