Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review

Abstract

Objective: This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes.Design: A systematic review. Methods: Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had followup periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction.Results: Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances.Conclusions: Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

A novel active intraoral appliance for presurgical orthopaedic treatment in patients with complete bilateral cleft lip and palate

“…Although several studies have examined the long-term effects of presurgical orthopaedic treatment in patients with unilateral cleft lip and palate, 5,6 there are few systematic reviews or randomised clinical trials concerning patients with complete bilateral cleft lip and palate. Therefore, we consider that this remains a controversial subject for surgeons and orthodontists, especially in the case of patients with complete bilateral cleft lip and palate with a severely protruding/deviated premaxilla and wide cleft.…”

Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya

“…Among these is the presurgical orthopaedics. The use of presurgical orthopaedics is still controversial with a number of studies either showing that it has no role in the management of cleft lip or that it may have deleterious effects [8][9][10][11]. The main reason for the use of a presurgical orthopaedic device is to assist on the alignment of the premaxilla and hence enable easier repair of the muscle.…”

Presurgical Infant Orthopedics for Cleft Lip and Palate: A Review

“…Therefore, the pure effect of PSIO appliances is very difficult to assess because of the variety in timing and sequence of treatment protocols for both surgery and orthodontics. The major difficulty when comparing different presurgical orthopedic methods is the type of surgical technique, and whether performing sequential palatal closure (one or two stage) or GPP, at what age, the experience of the surgeon [49][50][51][52]. The debate on the ideal time for hard palate closure is not over so far.…”

“…In a similar manner, Uzel and Alparslan concluded in their systematic review that presurgical infant orthopedic appliances have no long-term positive effects in patients with cleft lip and palate and that more randomized controlled trials are necessary. They also added that the encouraging results on the effect of nasoalveolar molding appliances on nasal symmetry need to be supported by future randomized controlled trials [50].…”