Dentofacial Orthopaedics in Cleft Lip and Palate: A Comprehensive Review

Cleft lip and palate (CLP) is a congenital craniofacial anomaly characterised by disruption of the maxilla's form and growth, which involves both a defect in the bony structure and soft tissue that needs multidisciplinary rehabilitation. Dentofacial orthopaedic procedures are extraoral and intraoral forces used to move bone segments and shape and mould future development of the maxillofacial region from the neonatal stage to skeletal maturity. This narrative review summarises current orthopaedic techniques that are used before primary surgery, such as passive maxillary plates, active pin-retained appliances, and nasoalveolar moulding; during deciduous and mixed dentition stages, such as rapid maxillary expansion, protraction facemask therapy, and alternate rapid maxillary expansion and constriction; prior to and following alveolar bone grafting; and prior to and following orthognathic surgery in patients with established maxillary hypoplasia. Clinical evidence is critically evaluated with particular focus on treatment effectiveness, limits of treatment, skeletal and soft tissue outcomes, and clinical application in various stages of cleft rehabilitation. Presurgical orthopaedic procedures usually improve early nasolabial and alveolar form and may aid in surgical management, but it is unclear if skeletal effects are durable and if the skull shape of one procedure is more effective than the other. New technology, such as digitally designed and three-dimensional-printed moulding appliances, temporary skeletal anchorage for maxillary protraction, distraction, and tissue-engineering techniques, is increasing therapeutic options for patients with CLP. Randomised trials with well-designed multicentre randomised trials, standardised outcome measures, and longer follow-up are needed to assess the effectiveness of treatment and facilitate individual orthopaedic management in the future.