Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2014; 47(03): 293-302
DOI: 10.4103/0970-0358.146573
Review Article
Association of Plastic Surgeons of India

Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

P. Priyanka Niranjane
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
,
R. H. Kamble
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
,
S. Pallavi Diagavane
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
,
S. Sunita Shrivastav
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
,
Puneet Batra
1   Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Modinagar, Kadrabad, Meerut, Uttar Pradesh, India
,
S. D. Vasudevan
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, India
,
Pushkar Patil
2   Private Practise, Dhule, Maharashtra, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 August 2019 (online)

Also available at
  Permissions and Reprints

ABSTRACT

Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.

KEY WORDS

Bilateral cleft lip and palate - long-term results - nasoalveolar moulding - presurgical infant orthopaeidcs - unilateral cleft lip and palate
 

  • REFERENCES

  • 1 McNeil CK. Congenital oral deformities. Br Dent J 1956; 18: 191-8
    Search in Google Scholar
  • 2 Hotz M, Gnoinski W. Comprehensive care of cleft lip and palate children at Zürich university: A preliminary report. Am J Orthod 1976; 70: 481-504
    CrossrefPubMedSearch in Google Scholar
  • 3 Hotz MM, Gnoinski WM. Effects of early maxillary orthopaedics in coordination with delayed surgery for cleft lip and palate. J Maxillofac Surg 1979; 7: 201-10
    CrossrefPubMedSearch in Google Scholar
  • 4 Huddart AG. Presurgical changes in unilateral cleft palate subjects. Cleft Palate J 1979; 16: 147-57
    PubMedSearch in Google Scholar
  • 5 Weil J. Orthopaedic growth guidance and stimulation for patients with cleft lip and palate. Scand J Plast Reconstr Surg Hand Surg 1987; 21: 57-63
    PubMedSearch in Google Scholar
  • 6 Hochban W, Austermann KH. Presurgical orthopaedic treatment using hard plates. J Craniomaxillofac Surg 1989; 17 Suppl (Suppl. 01) 2-4
    PubMedSearch in Google Scholar
  • 7 Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999; 36: 486-98
    CrossrefPubMedSearch in Google Scholar
  • 8 Matsuo K, Hirose T, Otagiri T, Norose N. Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period. Plast Reconstr Surg 1989; 83: 25-31
    CrossrefPubMedSearch in Google Scholar
  • 9 Maull DJ, Grayson BH, Cutting CB, Brecht LL, Bookstein FL, Khorrambadi D. et al. Long-term effects of nasoalveolar molding on three-dimensional nasal shape in unilateral clefts. Cleft Palate Craniofac J 1999; 36: 391-7
    CrossrefPubMedSearch in Google Scholar
  • 10 Grayson BH, Cutting CB. Presurgical nasoalveolar orthopedic molding in primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. Cleft Palate Craniofac J 2001; 38: 193-8
    CrossrefPubMedSearch in Google Scholar
  • 11 Suri S, Tompson BD. A modified muscle-activated maxillary orthopedic appliance for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate. Cleft Palate Craniofac J 2004; 41: 225-9
    CrossrefPubMedSearch in Google Scholar
  • 12 Singh GD, Levy-Bercowski D, Santiago PE. Three-dimensional nasal changes following nasoalveolar molding in patients with unilateral cleft lip and palate: Geometric morphometrics. Cleft Palate Craniofac J 2005; 42: 403-9
    CrossrefPubMedSearch in Google Scholar
  • 13 Ross RB, MacNamera MC. Effect of presurgical infant orthopedics on facial esthetics in complete bilateral cleft lip and palate. Cleft Palate Craniofac J 1994; 31: 68-73
    CrossrefPubMedSearch in Google Scholar
  • 14 Kuijpers-Jagtman AM, Ross Jr EL. The influence of surgery and orthopedic treatment on maxillofacial growth and maxillary arch development in patients treated for orofacial clefts. Cleft Palate Craniofac J 2000; 37: 527-39
    CrossrefSearch in Google Scholar
  • 15 Mishima K, Mori Y, Sugahara T, Minami K, Sakuda M. Comparison between palatal configurations in UCLP infants with and without a Hotz plate until four years of age. Cleft Palate Craniofac J 2000; 37: 185-90
    CrossrefPubMedSearch in Google Scholar
  • 16 Prahl C, Kuijpers-Jagtman AM, van’t Hof MA, Prahl-Andersen B. A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci 2001; 109: 297-305
    CrossrefPubMedSearch in Google Scholar
  • 17 Konst EM, Prahl C, Weersink-Braks H, De Boo T, Prahl-Andersen B, Kuijpers-Jagtman AM. 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). Cleft Palate Craniofac J 2004; 41: 71-7
    CrossrefPubMedSearch in Google Scholar
  • 18 Berkowitz S. Cleft Lip and Palate. 2 nd ed.. Berlin: Springer-Verlag; 2006
    Search in Google Scholar
  • 19 Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: A three-year follow-up study. Plast Reconstr Surg 2004; 114: 858-64
    CrossrefPubMedSearch in Google Scholar
  • 20 Lee CT, Garfinkle JS, Warren SM, Brecht LE, Cutting CB, Grayson BH. Nasoalveolar molding improves appearance of children with bilateral cleft lip-cleft palate. Plast Reconstr Surg 2008; 122: 1131-7
    CrossrefPubMedSearch in Google Scholar
  • 21 Ezzat CF, Chavarria C, Teichgraeber JF, Chen JW, Stratmann RG, Gateno J. et al. Presurgical nasoalveolar molding therapy for the treatment of unilateral cleft lip and palate: A preliminary study. Cleft Palate Craniofac J 2007; 44: 8-12
    CrossrefPubMedSearch in Google Scholar
  • 22 Singh GD, Levy-Bercowski D, Yáñez MA, Santiago PE. Three-dimensional facial morphology following surgical repair of unilateral cleft lip and palate in patients after nasoalveolar molding. Orthod Craniofac Res 2007; 10: 161-6
    CrossrefPubMedSearch in Google Scholar
  • 23 Severens JL, Prahl C, Kuijpers-Jagtman AM, Prahl-Andersen B. Short-term cost-effectiveness analysis of presurgical orthopedic treatment in children with complete unilateral cleft lip and palate. Cleft Palate Craniofac J 1998; 35: 222-6
    CrossrefPubMedSearch in Google Scholar
  • 24 Prahl-Andersen B. Dental treatment of predental and infant patients with clefts and craniofacial anomalies. Cleft Palate Craniofac J 2000; 37: 528-32
    CrossrefPubMedSearch in Google Scholar
  • 25 Huddart AG. The effect of form and dimension on the management of the maxillary arch in unilateral cleft lip and palate conditions. Scand J Plast Reconstr Surg Hand Surg 1987; 21: 53-6
    PubMedSearch in Google Scholar
  • 26 Ross RB. Treatment variables affecting facial growth in unilateral cleft lip and palate Part 2: Presurgical orthopedics. Cleft Palate Craniofac J 1987; 24: 24-32
    Search in Google Scholar
  • 27 Gnoinski WM. Orofacial development up to age 15 in UCLP cases treated according to the current Zurich approach. In: Pfeiffer G. editor Craniofacial Anomalies and Clefts of Lip, Alveolus and Palate. Principles of Treatment, Long Term Results. Stuttgart: G. Thieme; 1989
    Search in Google Scholar
  • 28 Kramer GJ, Hoeksma JB, Prahl-Andersen B. Early palatal changes in complete and incomplete cleft lip and/or palate. Acta Anat (Basel) 1992; 144: 202-12
    CrossrefPubMedSearch in Google Scholar
  • 29 Kramer GJ, Hoeksma JB, Prahl-Andersen B. Palatal changes after lip surgery in different types of cleft lip and palate. Cleft Palate Craniofac J 1994; 31: 376-84
    CrossrefPubMedSearch in Google Scholar
  • 30 Larson M, Sällström KO, Larson O, McWilliam J, Ideberg M. Morphologic effect of preoperative maxillofacial orthopedics (T-traction) on the maxilla in unilateral cleft lip and palate patients. Cleft Palate Craniofac J 1993; 30: 29-34
    CrossrefPubMedSearch in Google Scholar
  • 31 Ball JV, DiBiase DD, Sommerlad BC. Transverse maxillary arch changes with the use of preoperative orthopedics in unilateral cleft palate infants. Cleft Palate Craniofac J 1995; 32: 483-8
    CrossrefPubMedSearch in Google Scholar
  • 32 Kozelj V. The basis for presurgical orthopedic treatment of infants with unilateral complete cleft lip and palate. Cleft Palate Craniofac J 2000; 37: 26-32
    CrossrefPubMedSearch in Google Scholar
  • 33 Opitz C, Kratzsch H. Maxilla dimension in patients with unilateral and bilateral cleft lip and palate. Changes from birth until palate surgery at age three. J Orofac Orthop 1997; 58: 110-23
    PubMedSearch in Google Scholar
  • 34 Mishima K, Sugahara T, Mori Y, Sakuda M. Three-dimensional comparison between the palatal forms in infants with complete unilateral cleft lip, alveolus, and palate with and without Hotz plate. Cleft Palate Craniofac J 1996; 33: 77-83
    CrossrefPubMedSearch in Google Scholar
  • 35 Mishima K, Sugahara T, Mori Y, Sakuda M. Three-dimensional comparison between the palatal forms in complete unilateral cleft lip and palate with and without Hotz plate from cheiloplasty to palatoplasty. Cleft Palate Craniofac J 1996; 33: 312-7
    CrossrefPubMedSearch in Google Scholar
  • 36 Mishima K, Sugahara T, Mori Y, Sakuda M. Comparison of palatal forms in complete unilateral cleft lip and palate infants with and without a Hotz plate. In: Lee ST, Huang M. editors Transactions of the 8 th International Congress on Cleft Palate and Related Craniofacial Anomalies. Singapore: Stamford Press; 1997: p. 394-7
    Search in Google Scholar
  • 37 Kuijpers-Jagtman AM, Prahl C. A study into the effects of presurgical orthopaedic treatment in complete unilateral cleft lip and palate patients. A three centre prospective clinical trial in Nijmegen, Amsterdam and Rotterdam. Interim analysis. Nijmegen: University Press; 1996
    Search in Google Scholar
  • 38 Prahl C, Kuijpers-Jagtman AM, Prahl-Andersen B. Effect of presurgical infant orthopedics on maxillary arch dimensions. In: Lee ST, Huang M. editors Transactions 8th International Congress on Cleft Palate and Related Craniofacial Anomalies. Singapore: Stamford Press; 1997: p. 1026
    Search in Google Scholar
  • 39 Bongaarts CA, Kuijpers-Jagtman AM, van’t Hof MA, Prahl-Andersen B. The effect of infant orthopedics on the occlusion of the deciduous dentition in children with complete unilateral cleft lip and palate (Dutchcleft). Cleft Palate Craniofac J 2004; 41: 633-41
    CrossrefPubMedSearch in Google Scholar
  • 40 Bongaarts CA, van’t Hof MA, Prahl-Andersen B, Dirks IV, Kuijpers-Jagtman AM. Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft). Cleft Palate Craniofac J 2006; 43: 665-72
    CrossrefPubMedSearch in Google Scholar
  • 41 Bongaarts CA, Prahl-Andersen B, Bronkhorst EM, Prahl C, Ongkosuwito EM, Borstlap WA. et al. Infant orthopedics and facial growth in complete unilateral cleft lip and palate until six years of age (Dutchcleft). Cleft Palate Craniofac J 2009; 46: 654-63
    CrossrefPubMedSearch in Google Scholar
  • 42 Mars M, Asher-McDade C, Brattström V, Dahl E, McWilliam J, Mølsted K. et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 3. Dental arch relationships. Cleft Palate Craniofac J 1992; 29: 405-8
    CrossrefPubMedSearch in Google Scholar
  • 43 Mølsted K, Asher-McDade C, Brattström V, Dahl E, Mars M, McWilliam J. et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 2. Craniofacial form and soft tissue profile. Cleft Palate Craniofac J 1992; 29: 398-404
    CrossrefPubMedSearch in Google Scholar
  • 44 Mølsted K, Brattström V, Prahl-Andersen B, Shaw WC, Semb G. The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 3: Dental arch relationships. Cleft Palate Craniofac J 2005; 42: 78-82
    CrossrefPubMedSearch in Google Scholar
  • 45 Lee CT, Grayson BH, Cutting CB, Brecht LE, Lin WY. Prepubertal midface growth in unilateral cleft lip and palate following alveolar molding and gingivoperiosteoplasty. Cleft Palate Craniofac J 2004; 41: 375-80
    CrossrefPubMedSearch in Google Scholar
  • 46 Adali N, Mars M, Petrie A, Noar J, Sommerlad B. Presurgical orthopedics has no effect on archform in unilateral cleft lip and palate. Cleft Palate Craniofac J 2012; 49: 5-13
    CrossrefPubMedSearch in Google Scholar
  • 47 Ringdahl L. The Long-term effect of nasoalveolar molding on midface Growth and nasolabial esthetics in complete unilateral cleft lip and palate patients. Dissertation submitted to the South western University. http://www.gateway.proquest.com/openurl%3furl_ver=Z39.882004%26res_dat=xri:pqdiss%26rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation%26rft_dat=xri:pqdiss:1505904 [Last accessed September 2013]
  • 48 Matsuo K, Hirose T. Preoperative non-surgical over-correction of cleft lip nasal deformity. Br J Plast Surg 1991; 44: 5-11
    CrossrefPubMedSearch in Google Scholar
  • 49 Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg 1993; 92: 1422-3
    PubMedSearch in Google Scholar
  • 50 Grayson BH, Santiago PE. Presurgical orthopaedics for cleft lip and palate. In: Aston SJ, Beasley RW, Thorne CHM. editors Grabb and Smith’s Plastic Surgery. 5th ed.. Philadelphia: Lippincott-Raven; 1997: p. 237-44
    Search in Google Scholar
  • 51 Bennun RD, Perandones C, Sepliarsky VA, Chantiri SN, Aguirre MI, Dogliotti PL. Nonsurgical correction of nasal deformity in unilateral complete cleft lip: A 6-year follow-up. Plast Reconstr Surg 1999; 104: 616-30
    CrossrefPubMedSearch in Google Scholar
  • 52 Barillas I, Dec W, Warren SM, Cutting CB, Grayson BH. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients. Plast Reconstr Surg 2009; 123: 1002-6
    CrossrefPubMedSearch in Google Scholar
  • 53 Sulaiman FK, Haryanto IG, Hak S, Nakamura N, Sasaguri M, Ohishi M. Fifteen-Year Follow-Up Results of Presurgical Orthopedics Followed by Primary Correction for Unilateral Cleft Lip Nose in Program SEHATI in Indonesia. Cleft Palate Craniofac J 2013; 50: 129-37
    CrossrefPubMedSearch in Google Scholar
  • 54 van der Heijden P, Dijkstra PU, Stellingsma C, van der Laan BF, Korsten-Meijer AG, Goorhuis-Brouwer SM. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: A call for unified research. Plast Reconstr Surg 2013; 131: 62e-71
    CrossrefPubMedSearch in Google Scholar
  • 55 Karling J, Larson O, Leanderson R, Henningsson G. Speech in unilateral and bilateral cleft palate patients from Stockholm. Cleft Palate Craniofac J 1993; 30: 73-7
    CrossrefPubMedSearch in Google Scholar
  • 56 Suzuki K, Yamazaki Y, Sezaki K, Nakakita N. The effect of preoperative use of an orthopedic plate on articulatory function in children with cleft lip and palate. Cleft Palate Craniofac J 2006; 43: 406-14
    CrossrefPubMedSearch in Google Scholar
  • 57 Konst EM, Rietveld T, Peters HF, Kuijpers-Jagtman AM. Language skills of young children with unilateral cleft lip and palate following infant orthopedics: A randomized clinical trial. Cleft Palate Craniofac J 2003; 40: 356-62
    CrossrefPubMedSearch in Google Scholar
  • 58 Uzel A, Alparslan ZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: A systematic review. Cleft Palate Craniofac J 2011; 48: 587-95
    CrossrefPubMedSearch in Google Scholar
  • 59 Chang CS, Por YC, Liou EJ, Chang CJ, Chen PK, Noordhoff MS. Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: A single surgeon’s experience. Plast Reconstr Surg 2010; 126: 1276-84
    CrossrefPubMedSearch in Google Scholar
  • 60 Yeow VK, Chen PK, Chen YR, Noordhoff SM. The use of nasal splints in the primary management of unilateral cleft nasal deformity. Plast Reconstr Surg 1999; 103: 1347-54
    CrossrefPubMedSearch in Google Scholar
  • 61 Shaw WC, Brattström V, Mølsted K, Prahl-Andersen B, Roberts CT, Semb G. The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 5: discussion and conclusions. Cleft Palate Craniofac J 2005; 42: 93-8
    CrossrefPubMedSearch in Google Scholar
  • 62 Russell K, Long Jr RE, Hathaway R, Daskalogiannakis J, Mercado A, Cohen M. 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. Cleft Palate Craniofac J 2011; 48: 265-70
    CrossrefPubMedSearch in Google Scholar
  • 63 Hak MS, Sasaguri M, Sulaiman FK, Hardono ET, Suzuki A, Nakamura S. et al. Longitudinal study of effect of hotz’s plate and lip adhesion on maxillary growth in bilateral cleft lip and palate patients. Cleft Palate Craniofac J 2012; 49: 230-6
    CrossrefPubMedSearch in Google Scholar
  • 64 Roberts-Harry D, Semb G, Hathorn I, Killingback N. Facial growth in patients with unilateral clefts of the lip and palate: A two-center study. Cleft Palate Craniofac J 1996; 33: 489-93
    CrossrefPubMedSearch in Google Scholar