Functional Presurgical Infant Orthopedics in Unilateral Cleft Lip and Palate: Parallel Palatal Cleft Reduction

This case series evaluates the outcome of a functional presurgical infant orthopedic approach (Fun-PSIO) using a combined 2- and 3-dimensional morphometric assessment based on the anatomic landmarks described by Mazaheri and Botticelli. Grounded in the biological and biomechanical principles of functional maxillary orthopedics (FMO), customized intraoral devices (Fun-Plates) incorporate externally carved acrylic grooves that create a textured surface designed to elicit a tactile-proprioceptive response from the tongue. This neuromuscular stimulation may enhance tongue activity and guide maxillary segment growth and alignment before cheilorhinoplasty. Conducted in low-resource settings, 5 consecutive infants with unilateral cleft lip and palate treated from birth were evaluated at 2 treatment stages. Quantitative analyses indicated reductions in alveolar and palatal cleft widths along the entire cleft extension, with a parallel reduction of the palatal cleft-including the mid- and posterior regions-together with increases in maxillary width and length and a trend toward prevention of T-shaped residual defects. These findings suggest that this functional presurgical approach may contribute to a more favorable surgical field for primary repair, particularly by promoting a parallel palatal cleft configuration along its entire extent, including the posterior region, thereby facilitating tension-reduced closure in infants with unilateral cleft lip and palate.