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  11. Effectiveness Of Presurgical Orthopedic Interventions In Infants With Unilateral Cleft Lip And Palate: A Systematic Review And Network Meta-analysis

Effectiveness of Presurgical Orthopedic Interventions in Infants With Unilateral Cleft Lip and Palate: A Systematic Review and Network Meta-Analysis

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.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|November 10, 2025

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View abstract on PubMed

Summary
This summary is machine-generated.

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literature search was conducted following PRISMA guidelines, including electronic databases, gray literature, and unpublished materials.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.
Keywords:
DynacleftFigueroaGraysonUCLP

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  • 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.
    digital NAM
    naso-alveolar molding
    network meta-analysis
    passive molding