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
Authors: Thiruvenkatachari Badri , Bonanthaya Krishnamurthy , Kuijpers Jagtman Anne Marie , Sandler Jonathan , Powar Rajesh S , Hussain Syed Altaf , Subramaniyan B. , Bhola Nitin , Bhat Hari Kishore , Ramachandra Varun , Jayakumar Sylvia , Batra Puneet , Chakkaravarthi Subhiksha , Thailavathy V. , Prathap Manoj , Elumalai Thulasiram , Nambiar Karthika , Vijayakumar Charanya , Mahajan Ravi Kumar , Sood Sundereshwer Chander , Kahlon Sukhdeep Singh , Bijapur Shruti , Kamble Ranjit Haridas , Keluskar K. M. , Nilgar Amit , Khan Faizan Ahmed , Das Devika , Sridhar Swetha , Buch Adrija , Kumar Shuba , Mohanraj Rani , Listl Stefan , Chopra Samiksha , Jadhav Vikrant , Arora Anika , Valiya Chintan , Pattamata Madhuri 
Published: July 2024

Abstract
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
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
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
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).