Abstract
Cleft lip and palate is one of the most common birth defects occurring 1 of every 700 live births. Historically, cleft lip and palate care typically involves the use of presurgical infant orthopedics appliances (PIOA) fabricated by a pediatric dentist as an adjunct to the overall management of the defect approximate the cleft segments prior to surgical repair. However, the necessity of presurgical orthopedics in managing the resulting orofacial deformity is still one that elicits discussion by craniofacial teams due to the variety of methodologies available and the inconsistency in long-term results produced by these devices. Nonetheless, presurgical orthopedics used for patients with cleft lip and palate remains primarily focused on four types' devices which have produced varied results; however, there are other techniques which offer promising results. In spite of contradictory findings, presurgical orthopedics is believed to be a vital influence on growth in cleft life and palate deformities.
Highlights
Craniofacial anomalies are birth defects of the skull and face
With skyrocketing health care costs and continued efforts to increase quality and efficiency in healthcare, the use of presurgical orthopedics in cleft lip and palate care may evolve from an option to a necessity for patients [4]
Additional benefits of presurgical infant orthopedics include the normalization of feeding and tongue function, better speech development, reduced risk of aspiration, and reduced severity of dental and skeletal deviations [8]
Summary
Craniofacial anomalies are birth defects of the skull and face. Tens of thousands of infants in the United States are affected each year. Additional benefits of presurgical infant orthopedics include the normalization of feeding and tongue function, better speech development, reduced risk of aspiration, and reduced severity of dental and skeletal deviations [8]. Concerns regarding the use of presurgical infant orthopedics focus on their cost, long-term effects, restrictions on maxillary growth, negative effects on speech, and benefits not lasting longer than surgical soft palate closure [11,12,13]. Several authors have reported that presurgical orthopedics have resulted in several benefits to patients with cleft lip and palate such as: a reduction in cleft width by stimulation of patalal shelf growth, improved maxillary arch development, improved growth of the face and infant overall, improved occlusion, feeding, speech, hearing, and language development [17]. Even though long term studies have shown that more anterior and posterior cross-bites occurred in children treated with the Latham appliance, Chan et al concluded that the Latham appliance did not affect dental arch relationships in preadolescent children [28]
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