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Effectiveness of Presurgical Orthopedic Interventions in Infants With Unilateral Cleft Lip and Palate: A Systematic
Mrudula Desale1, Rigzin Tamchos1, Aditi Kapur1
1Oral Health Science Centre, Post Graduate Institute of Medical Education and Research, Unit of Pedodontics and Preventive Dentistry, Chandigarh, India.
Insights
Presurgical orthopedic (PSO) appliances improve alveolar gaps and nasal shape in infants with unilateral cleft lip and palate. The Grayson technique best reduced alveolar gaps, while Figueroa and Dynacleft techniques improved columella angle.
Area of Science:
- Craniofacial Surgery
- Pediatric Dentistry
- Plastic Surgery
Background:
- Infants with unilateral cleft lip and palate (UCLP) often exhibit alveolar segment misalignment and nasal asymmetry.
- Presurgical orthopedic (PSO) appliances are used to improve these deformities before surgical repair.
- The comparative effectiveness of various PSO appliances on specific outcomes remains an area of active research.
Purpose of the Study:
- To systematically evaluate and compare the effects of different Presurgical Orthopedic (PSO) appliances on alveolar segment alignment and nasal morphology in infants with unilateral cleft lip and palate (UCLP).
Main Methods:
- A comprehensive systematic literature search was conducted following PRISMA guidelines, including electronic databases, gray literature, and unpublished materials.
- Study quality was assessed using ROBINS-I and Cochrane RoB 2 tools.
- A Frequentist network meta-analysis (NMA) was performed on data from 21 included studies (9 RCTs, 8 prospective, 4 retrospective) to compare PSO interventions.
Main Results:
- The Grayson's NAM technique demonstrated the greatest reduction in alveolar gap width (-10.00 mm).
- The Figueroa presurgical nasoalveolar molding technique showed the most significant improvement in columella angle (17.50 degrees), followed by Dynacleft with Nasal elevator (15.34 degrees).
- While all PSO techniques showed improvements, specific techniques were more effective for distinct outcomes without statistically significant differences between them.
Conclusions:
- All evaluated Presurgical Orthopedic (PSO) techniques contribute to reducing alveolar cleft width and improving columella angle in infants with UCLP.
- The Grayson technique is particularly effective for alveolar gap reduction.
- The Figueroa and Dynacleft with Nasal elevator techniques show superior outcomes for columella angle improvement.
Abstract:
ObjectiveTo assess the effects of different Presurgical Orthopedic (PSO) appliances on alignment of alveolar segments and nasal morphology in infants with unilateral cleft lip and palate.MethodologyA comprehensive electronic search was performed across health science databases up to March 23, 2025, supplemented by manual searching, gray literature, and unpublished material, following PRISMA guidelines. Study quality was evaluated using ROBINS-I (Risk Of Bias In Nonrandomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tools. Included studies were randomized controlled trials (RCTs) or non-RCTs involving infants with unilateral cleft lip and palate treated with PSO techniques, focusing on alveolar segment alignment and nasal morphology. Quantitative data were analyzed through a Frequentist network meta-analysis (NMA) using Python and meta-insight software to compare the effectiveness of different PSO interventions.ResultsTwenty-one studies (9 RCTs, 8 prospective, and 4 retrospective) were included. The network meta-analysis revealed that Grayson's NAM achieved the greatest reduction in alveolar gap width [- 10.00 (95% confidence interval (CI) -12.22; -7.78)]mm while the Figueroa presurgical nasoalveolar molding technique showed the most improvement in columella angle (17.50, 95% CI [6.61, 28.39]) degrees followed by Dynacleft with Nasal elevator [15.34, 95% CI (-0.07, 30.75)] degrees from the baseline.ConclusionAll PSO techniques demonstrated improvements in alveolar cleft width reduction and columella angle enhancement, with the Grayson technique for alveolar cleft width reduction and the Figueroa technique and Dynacleft with Nasal elevator technique for columella angle, being more effective than the others without being statistically different.PROSPERO Registration number: CRD42025632490.
