Sameer Malik*

Lecturer, Department of Orthodontics and Dentofacial Orthopedics, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India

*Corresponding Author: Sameer Malik, Lecturer, Department of Orthodontics and Dentofacial Orthopedics, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India.

Received: June 20, 2025; Published: June 30, 2025

Abstract

Background: Pre-surgical infant orthopedics (PSIO) has evolved significantly since the mid-20th century and is a critical component in the early management of cleft lip and/or palate (CL/P).

Objective: To provide a comprehensive review of PSIO techniques, including traditional methods and recent innovations such as nasoalveolar molding (NAM) and 3D printing.

Methods: A literature-based review highlighting the evolution, clinical applications, protocols, materials, complications, and emerging trends in PSIO.

Results: Techniques vary in complexity and outcomes, with NAM and digital workflows offering enhanced customization. Complications are manageable with interdisciplinary collaboration.

Conclusion: Technological advances are reshaping PSIO, yet debates remain regarding efficacy and accessibility. A multidisciplinary, patient-centered approach remains essential.

Keywords:Pre-Surgical Infant Orthopedics (PSIO); Cleft Lip and Palate; Nasoalveolar Molding (NAM); Passive Orthopedic Appliances; Active Orthopedic Appliances; 3D-Printed Orthopedic Appliances

References

1. Hotz MM and Gnoinski WM. “Effects of early maxillary orthopaedics in coordination with delayed surgery for cleft lip and palate”. Journal of Oral and Maxillofacial Surgery 3 (1979): 201-210.
2. Hotz M and Gnoinski W. “Comprehensive care of cleft lip and palate children at Zürich university: A preliminary report”. American Journal of Orthodontics 70.5 (1976): 481-504.
3. Huddart AG. “Presurgical changes in unilateral cleft palate subjects”. The Cleft Palate Journal 16.2 (1979): 147-157.
4. Weil J. “Orthopaedic growth guidance and stimulation for patients with cleft lip and palate”. Scandinavian Journal of Plastic and Reconstructive Surgery Hand Surgery 21.1 (1987): 57-63.
5. Hochban W and Austermann KH. “Presurgical orthopaedic treatment using hard plates”. Journal of Cranio-Maxillofacial Surgery 17.1 (1989): 2-4.
6. Grayson BH., et al. “Presurgical nasoalveolar molding in infants with cleft lip and palate”. The Cleft Palate Craniofacial Journal 36.6 (1999): 486-498.
7. Matsuo K., et al. “Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period”. Plastic and Reconstructive Surgery 83.1 (1989): 25-31.
8. Maull DJ., et al. “Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts”. The Cleft Palate Craniofacial Journal 36.5 (1999): 391-397.
9. Grayson BH and Cutting CB. “Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts”. The Cleft Palate Craniofacial Journal 38.3 (2001): 193-198.
10. Suri S and Tompson BD. “A modified muscle-activated maxillary orthopedic appliance for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate”. The Cleft Palate Craniofacial Journal 41.3 (2004): 225-229.
11. Singh GD., et al. “Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: Geometric morphometrics”. The Cleft Palate Craniofacial Journal 42.5 (2005): 403-409.
12. Ross RB and MacNamera MC. “Effect of presurgical infant orthopedics on facial esthetics in complete bilateral cleft lip and palate”. The Cleft Palate Craniofacial Journal 31.1 (1994): 68-73.
13. Kuijpers-Jagtman AM and Ross EL Jr. “The influence of surgery and orthopedic treatment on maxillofacial growth and maxillary arch development in patients treated for orofacial clefts”. The Cleft Palate Craniofacial Journal 37.5 (2000): 527-539.
14. Mishima K., et al. “Comparison between palatal configurations in UCLP infants with and without a Hotz plate until four years of age”. The Cleft Palate Craniofacial Journal 37.2 (2000): 185-190.
15. Prahl C., et al. “A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft)”. European Journal of Oral Sciences109.5 (2001): 297-305.
16. Konst EM., et al. “Cost-effectiveness of infant orthopedic treatment regarding speech in patients with complete unilateral cleft lip and palate: A randomized three-center trial in the Netherlands (Dutchcleft)”. The Cleft Palate Craniofacial Journal 41.1 (2004): 71-77.
17. Berkowitz S. “Cleft Lip and Palate. 2^nd edition”. Berlin: Springer-Verlag (2006).
18. Liou EJ., et al. “The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study”. Plastic and Reconstructive Surgery 114.4 (2004): 858-864.
19. Lee CT., et al. “Nasoalveolar molding improves appearance of children with bilateral cleft lip-cleft palate”. Plastic and Reconstructive Surgery 122.4 (2008): 1131-1137.
20. Ezzat CF., et al. “Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: A preliminary study”. The Cleft Palate Craniofacial Journal 44.1 (2007): 8-12.
21. Singh GD., et al. “Three-dimensional facial morphology following surgical repair of unilateral cleft lip and palate in patients after nasoalveolar molding”. Orthodontics and Craniofacial Research 10.4 (2007): 161-166.
22. Severens JL., et al. “Short-term cost-effectiveness analysis of presurgical orthopedic treatment in children with complete unilateral cleft lip and palate”. The Cleft Palate Craniofacial Journal 35.3 (1998): 222-226.
23. Prahl-Andersen B. “Dental treatment of predental and infant patients with clefts and craniofacial anomalies”. The Cleft Palate Craniofacial Journal 37.5 (2000): 528-532.
24. Huddart AG. “The effect of form and dimension on the management of the maxillary arch in unilateral cleft lip and palate conditions”. Scandinavian Journal of Plastic and Reconstructive Surgery Hand Surgery 21.1 (1987): 53-56.
25. Ross RB. “Treatment variables affecting facial growth in unilateral cleft lip and palate. Part 2: Presurgical orthopedics”. The Cleft Palate Craniofacial Journal 24.1 (1987): 24-32.
26. Kramer GJ., et al. “Early palatal changes in complete and incomplete cleft lip and/or palate”. Acta Anatomica144.3 (1992): 202-212.
27. Kramer GJ., et al. “Palatal changes after lip surgery in different types of cleft lip and palate”. The Cleft Palate Craniofacial Journal 31.5 (1994): 376-384.
28. Larson M., et al. “Morphologic effect of preoperative maxillofacial orthopedics (T-traction) on the maxilla in unilateral cleft lip and palate patients”. The Cleft Palate Craniofacial Journal 30.1 (1993): 29-34.
29. Ball JV., et al. “Transverse maxillary arch changes with the use of preoperative orthopedics in unilateral cleft palate infants”. The Cleft Palate Craniofacial Journal 32.6 (1995): 483-488.
30. Kozelj V. “The basis for presurgical orthopedic treatment of infants with unilateral complete cleft lip and palate”. The Cleft Palate Craniofacial Journal 37.1 (2000): 26-32.
31. Opitz C and Kratzsch H. “Maxilla dimension in patients with unilateral and bilateral cleft lip and palate. Changes from birth until palate surgery at age three”. The Journal of Orofacial Orthopedics 58.2 (1997): 110-123.
32. Mishima K., et al. “Three-dimensional comparison between the palatal forms in infants with complete unilateral cleft lip, alveolus, and palate with and without Hotz plate”. The Cleft Palate Craniofacial Journal 33.1 (1996): 77-83.
33. Konst EM., et al. “Language skills of young children with unilateral cleft lip and palate following infant orthopedics: A randomized clinical trial”. The Cleft Palate Craniofacial Journal 40.4 (2008): 356-362.
34. Uzel A and Alparslan ZN. “Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: A systematic review”. The Cleft Palate Craniofacial Journal 48.6 (2011): 587-595.
35. Chang CS., et al. “Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon’s experience”. Plastic and Reconstructive Surgery 126.4 (200): 1276-1284.
36. Yeow VK., et al. “The use of nasal splints in the primary management of unilateral cleft nasal deformity”. Plastic and Reconstructive Surgery 103.5 (1999): 1347-1354.
37. Shaw WC., et al. “The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 5: Discussion and conclusions”. The Cleft Palate Craniofacial Journal 42.1 (2005): 93-98.
38. Russell K., et al. “The Americleft study: An inter-center study of treatment outcomes for patients with unilateral cleft lip and palate. Part 5: General discussion and conclusions”. The Cleft Palate Craniofacial Journal 48.3 (2011): 265-270.
39. Hak MS., et al. “Longitudinal study of effect of Hotz’s plate and lip adhesion on maxillary growth in bilateral cleft lip and palate patients”. The Cleft Palate Craniofacial Journal 49.2 (2012): 230-236.

Citation

Citation: Sameer Malik., et al. “Pre-Surgical Infant Orthopedics: An Up-To-Date Review of Techniques and Clinical Implications". Acta Scientific Dental Sciences 9.7 (2025): 30-40.

Copyright

Copyright: © 2025 Chandrasekharan Nair K., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.