Infant Orthopedics Research Articles

Orthodontic treatment of patients with cleft lip and palate from birth through maturity

Cleft lip and palate (CLP) is one of the most common congenital anomalies, requiring lifelong care by a team of craniofacial specialists. A key member of that team is the craniofacial orthodontist, who provides treatment for these patients throughout the lifetime. This care actually begins prenatally, when families first meet with a craniofacial team. The family is provided with resources to prepare for their child's arrival and counseled about future treatment. Presurgical infant orthopedics (PSIO) will usually begin within a week of birth and continues for 3–5 months. PSIO helps approximate the lip and alveolar segments and reshapes the nostrils to facilitate primary surgical repairs. This is followed by a phase of monitoring growth and dental development throughout childhood, as patients with CLP are at increased risk for dental anomalies. Once the maxillary canine roots are one-third developed, the patient will be prepared for secondary alveolar bone grafting. This may include expansion, alignment, and/or maxillary protraction via facemask therapy. A short phase of maxillary dental alignment might follow if functional or esthetic concerns arise. Comprehensive orthodontic treatment is then performed at skeletal maturity, and coordinated with orthognathic surgery when indicated. The orthodontist and surgeon will collaborate closely in planning and managing the surgical correction. It is crucial that each stage of orthodontics is followed by an appropriate retention protocol. Finally, surgical and esthetic finishing procedures take place after surgical orthodontics is complete. This may include surgery to address lip, nose, speech, and breathing concerns, as well as definitive dental restorations.

A Bibliometric Analysis of 100 Top-cited Articles on Cleft Orthodontics.

This bibliometric study seeks to provide a comprehensive overview of the 100 most frequently cited articles in the domain of cleft orthodontics. The analysis will reveal key influential publications, collaborative author networks, and identify prevailing research themes within the field. The studies related to Orthodontics in the realm of cleft lip and palate (CLP) were retrieved from the Scopus database on 30th August 2024 using key terms. The results obtained were sorted in descending order of citations and the 100 top-cited articles were hand-filtered. RStudio software version 4.2.0 and Bibliometrix R-package was used for performing scientometrics involving co-citation, co-occurrence, collaboration and co-word analyses, bibliographic coupling and network mapping. A total of n = 3984 articles were retrieved from which top-100 cited articles were filtered. These documents were published during 1950-2019 with peak production in 1997. The United States and the Netherlands were the most prolific countries involved in the given research. The majority of the highly referenced articles pertained to alveolar bone grafting, and treatment outcomes being the second common focus followed by Infant and early orthopedics (Naso-alveolar moulding, Maxillary Protraction) and facial growth during the given period. Thematic mapping depicted bone grafting, alveoloplasty (infant orthopedics) and maxillofacial development as the more developed core topics than the psychology and self-perception of patients with CLP. Recent research trends have shifted towards three-dimensional assessment methods.

Research Trends in Presurgical Infant Orthopaedic Treatment in Patients with Cleft Lip and Palate: A Bibliometric Analysis of 100 Most-Cited Articles.

To assess research trends and publication patterns of literature related to presurgical infant orthopaedics (PSIO) through a bibliometric analysis of the top 100 most-cited articles. The top 100 most-cited articles were identified in the Web of Science (WoS) database using search terms related to PSIO on April 23, 2024, without any restrictions to study design, publication date and language. Standard information about each study was extracted. Citations from WoS, Scopus and PubMed databases were compared. The level of evidence for each article included was assessed. Association between different variables was calculated using Spearman's correlation coefficient with statistical significance set at p < 0.05. Visual analysis of the author's keyword co-occurrence, co-authorship analysis of authors, and citation analysis of journals and authors were performed using VOSviewer. Top cited articles were published from 1994 to 2020, with total individual database citations being WoS (n = 5378), Scopus (n = 6184) and PubMed (n = 10 450). Eleven articles were considered classic articles. Cleft Palate and Craniofacial Journal (Impact Factor = 1.1) had a maximum number of articles and citations. Two hundred eighty-five individuals contributed to top-cited articles, with 62 corresponding authors from 19 countries. A maximum number of authors were affiliated with universities in the United States. The most common keyword used was "nasoalveolar molding (n = 24)", "cleft palate (n = 16)", and "infant orthopedics (n = 16)". The study design of the majority of articles was retrospective and follow-up studies (level 3; n = 53). A weak negative correlation was observed between citation metrics and both the publication year (P < 0.01) and the level of evidence (P < 0.01). This analysis recognises the contributions of experts and offers valuable insights into trends that have shaped the development and evidence related to PSIO research. Future research should focus on integrating advanced technologies, conducting longitudinal studies, fostering collaboration, and emphasizing patient-centred outcomes.

A cross-sectional analysis of the content and quality of presurgical infant orthopedics videos on YouTube.

Caregivers seeking additional information about Presurgical Infant Orthopedics (PSIO) may turn to online sources, but the quality of information on platforms like YouTube is uncertain. To investigate the content and quality of PSIO videos on YouTube. YouTube videos were searched using keywords related to PSIO appliances. Videos that met the eligibility criteria (n=52) were categorized as care provider or caregiver-based. Engagement metrics were analyzed and quality assessments were performed by two raters using the Global Quality Score (GQS), Video Information and Quality Index (VIQI), and Medical Quality Video Evaluation Tool (MQ-VET). Inter-rater and intra-rater correlations were high (r≥0.9; p<0.01), indicating excellent reliability. Strong correlations were observed between the GQS, VIQI, and MQ-VET scores (r: 0.86-0.91; p<0.01). Mean GQS (2.7±1.1), VIQI (13.0±4.1), and MQ-VET (42.6±12.4) scores indicated poor to moderate video quality. Most videos (73.1%) were in the care provider category and rated significantly higher (p<0.05) in quality than the caregiver category for all three indices, but not for video engagement metrics. YouTube PSIO videos are not comprehensive and lack quality. Caregivers of infants undertaking PSIO should seek advice from care providers and not rely solely on YouTube videos.

The nasoalveolar molding technique versus DynaCleft nasal elevator application in infants with unilateral cleft lip and palate.

The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

Presurgical Naso-alveolar molding in cleft lip and palate patients – A critical review

Purpose: To evaluate and assess the current scientific evidence pertains to the efficiency and usefulness of Presurgical Naso-alveolar molding (PSNAM) in cleft lip and cleft palate patients. Methods: A comprehensive scientific literature search was carried out using PUBMED electronic database which focus on the current concept of PSNAM and those which critically analyse its long term effects in the treatment of cleft lip, palate and nasal deformity, using different terminologies like the ‘presurgical nasoalveolar molding’, ‘nasal moulding’ and ‘infant orthopaedics’ and documented articles over a period of 30 years were selected for the critical review. Results: Following PUBMED search, a total of 58 articles were retrieved. These 58 articles were investigations pertaining to the effect of PSNAM on different aspects of cleft including effects of PSNAM on facial growth, maxillary arch, dentition and occlusion, its effects on nasal symmetry and nasolabial appearance, and on speech. Conclusions: Presurgical Naso-alveolar molding can be a useful adjunctive treatment modality for management of cleft lip and palate patients. This technique being a cost effective is more beneficial in reducing the number of future surgeries required in the management of cleft lip and palate patients.

Advances in Cleft Lip and Palate Surgery.

Cleft lip with or without cleft palate is one of the most common congenital malformations, with an average prevalence of 1 in 1000 live births. Cleft lip and/or palate is incredibly phenotypically diverse, with constant advancements and refinements in how we care for patients. This article presents an in-depth review of the latest advances and current evidence in cleft lip and palate surgery. This includes presurgical infant orthopedics, perioperative practice patterns including use of enhanced recovery after surgery (ERAS) protocols, patient-reported outcome measures, and the latest adjuncts in cheiloplasty and palatoplasty.

A novel modification of nasoalveolar molding procedure to enhance ease of use

Cleft lip and palate (CLP) is one of the most common craniofacial birth defects. Its incidence varies according to race, sex and region. As ubiquitous as the condition may be, when it comes to clinical presentation, CLP manifests in a myriad of forms and varieties. The most common clinical presentation is that of a unilateral cleft lip and palate (UCLP). Management of CLP is a challenging proposition but in recent times, the results have become better owing to standardization of treatment protocol and the availability of multidisciplinary teams at specialized cleft centers worldwide. Management of CLP is initiated right from birth with parental counselling followed by presurgical infant orthopedics (PSIO). Nasoalveolar moulding (NAM) is on of the most widely accepted modalities of PSIO and is used to achieve alignment of the cleft alveolar segments into a more ideal relationship prior to the primary lip repair surgery. In its bare essence, NAM uses an acrylic molding plate with selective addition and removal of soft liner to mould the segments into a more ideal position. The molding plate is held in place with elastics which are retained by the use of adherent tapes on the cheek. The use of these tapes on a young infant often leads to tissue irritation and results in reduced compliance and treatment effect. Herein this case report we aim to highlight a novel approach of retaining the molding plate which dispenses with the need of adherent tapes. This technique has the benefit of no tissue irritation, easier application and improved compliance.

Protocols in the management of cleft lip and palate: A systematic review

AimTo identify clinical decisions on surgical as well as non-surgical modalities for the treatment of CLP patients based on randomized controlled trials (RCTs). Materials and methodsPubMed, Ebscohost, and Cochrane Library were searched and 20 articles based on RCTs conducted on cleft patient management were identified. ResultsThe topics explored were infant orthopedics, lip and palate repair, alveolar bone grafting, and management of cleft maxillary hypoplasia. Nasoalveolar molding (NAM) was found to have great benefits when carried out within one month of birth. Fisher and Mohler's lip repair technique and use of recombinant human bone morphogenetic protein-2 (rh-BMP2) for alveolar bone grafting showed promising results. rh-BMP2 for alveolar bone grafting appears to be a promising alternative to autografts. ConclusionEarly commencement of NAM in neonatal life is of great benefit to cleft patients. There is a need for more multicentre collaborations, mainly to identify the ideal surgical technique to reduce the variability in treatment and to ensure that the patient receives appropriate evidence-based treatment.

Orofacial clefts lead to increased pro-inflammatory cytokine levels on neonatal oral mucosa.

Orofacial clefts (OFC) are frequent congenital malformations characterized by insufficient separation of oral and nasal cavities and require presurgical infant orthopedics and surgical interventions within the first year of life. Wound healing disorders and higher prevalence of gingivitis and plaque levels are well-known challenges in treatment of children with OFC. However, oral inflammatory mediators were not investigated after birth using non-invasive sampling methods so far. In order to investigate the impact of OFC on oral cytokine levels, we collected tongue smear samples from 15 neonates with OFC and 17 control neonates at two time points (T), T0 at first consultation after birth, and T1, 4 to 5 weeks later. The samples were analyzed using multiplex immunoassay. Overall, we found significantly increased cytokine levels (TNF, IL-1β/-2/-6/-8/-10) in tongue smear samples from neonates with OFC compared to controls, especially at T0. The increase was even more pronounced in neonates with a higher cleft severity. Further, we detected a significant positive correlation between cleft severity score and distinct pro-inflammatory mediators (GM-CSF, IL-1β, IL-6, IL-8) at T0. Further, we found that breast-milk (bottle) feeding was associated with lower levels of pro-inflammatory cytokines (IL-6/-8) in neonates with OFC compared to formula-fed neonates. Our study demonstrated that neonates with OFC, especially with high cleft severity, are characterized by markedly increased inflammatory mediators in tongue smear samples within the first weeks of life potentially presenting a risk for oral inflammatory diseases. Therefore, an inflammatory monitoring of neonates with (severe) OFC and the encouragement of mother to breast-milk (bottle) feed might be advisable after birth and/or prior to cleft surgery.

Evaluating the accuracy of intraoral direct digital impressions in 2 infants with unilateral cleft lip and palate compared with digitized conventional impression

Presurgical infant orthopedics was introduced as an interceptive approach for treating cleft lip and/or palate (CLP). This study aimed to evaluate the intraoral digital impression technique as a viable alternative to conventional impression in infants with unilateral CLP. Trios 3-Shape scanner (3Shape, Copenhagen, Denmark) was used for intraoral scanning of the infants' maxillary arches to provide a direct digital scan (DDS). In addition, conventional impressions of the same patients were taken in a hospital setting, and the resultant stone models were digitized using the same scanner to create an indirect digital scan (IDS). Both scans (DDS and IDS) were exported in stereolithography format, and the resultant stereolithography files were imported into computer-assisted-design software (Exocad DentalCAD; exocad GmbH, Darmstadt, Germany) for 3-dimensional surface model superimposition. Differences between the 2 surfaces were quantified in millimeters and visually displayed by a color map. Three-dimensional surface model superimposition of the DDS and IDS scans showed an excellent agreement between both approaches, in which differences ranged from 0.01 mm to 0.1 mm CONCLUSIONS: Intraoral direct digital impression in infants with unilateral CLP is a safe, accurate, and time-efficient technique, which can be a viable alternative to conventional impression. This will aid in overcoming the challenges and complications that are frequently associated with using conventional impressions in infants with unilateral CLP, thus reducing the burden of care not only on the patients' families but also on the care providers.

A comparative evaluation of presurgical infant orthopedics of modified Grayson’s technique with clear aligners incorporating a nasal elevator in patients with unilateral cleft lip and palate

To assess the differences between 2 methods of presurgical infant orthopedics: the modified Grayson's technique and a new technique using clear aligners in patients with complete unilateral cleft lip and palate. For this prospective comparative cohort study, 30 patients were divided into 2 groups: group A (modified Grayson technique) and group B (clear aligner trays), with 15 patients each. Scanned cast measurements were taken before and after treatment and evaluated using an appropriate 3-dimensional software assessing treatment changes in the alveolus (eg, reduction of width between major and minor segment, angulation change of each respective segment [intragroup and intergroup, respectively]). This was supplemented with standardized anterioposterior, Worms-eye view, and profile photographs assessing changes in columellar angle, nostril width, height, nasolabial angle, and soft-tissue cleft gap. Furthermore, the number of visits for each patient group was also tabulated and assessed. The differences were compared using the independent t test and Mann-Whitney U test for the respective parameters. Groups A and B showed similar posttreatment changes, with no overt significant differences. However, there was a statistically significant difference in the number of visits (P<0.05), with group B having much lower visits to the center than group A. The posttreatment values matched previously established growth reference values. The analysis of photographic measurements showed improved nasal asymmetry in both groups without any significant difference. Because there was no difference in the treatment results between the 2 methods and a reduction in the number of required patient visits, presurgical infant orthopedics via clear aligners could pave the way for a more patient-efficient approach.

Current Presurgical Infant Orthopedics Practices Among American Cleft Palate Association-Approved Cleft Teams in North America.

Presurgical infant orthopedic (PSIO) therapy has evolved in both its popularity and focus of treatment since its advent. Nasoalveolar molding, nasal elevators, the Latham appliance, lip taping, and passive plates are the modern treatment options offered by cleft teams. Many cleft surgeons also employ postsurgical nasal stenting (PSNS) after the primary lip repair procedure. The purpose of this study is to examine trends in current PSIO care as well as PSNS for the management of patients with cleft lip and palate. An electronic survey was distributed to cleft team coordinators listed by the American Cleft Palate Association. The survey reported on team setting, provider availability, PSIO offerings, contraindications, and use of PSNS. Descriptive statistics and analyses were performed using MS Excel and SPSS. A total of 102 survey responses were received. The majority of settings were children's specialty hospitals (66%) or university hospitals (27%). Presurgical infant orthopedics was offered by 86% of cleft teams, and the majority of those (68%) provided nasoalveolar molding. Nasal elevators and lip taping are offered at 44% and 53% of centers, respectively. Latham and passive plates are both offered at 5.5% of centers. Most centers had an orthodontist providing treatment. The majority of centers use PSNS (86%). Nasoalveolar molding is the most popular PSIO technique in North American cleft centers followed by the nasal elevator, suggesting that the nasal molding component of PSIO is of critical influence on current treatment practices.

Does YouTubeTM Offer High-Quality Information About Nasoalveolar Molding?

To assess the content and quality of YouTubeTM videos concerning nasoalveolar molding (NAM). YouTubeTM was searched for videos containing information relevant to NAM with the 2 keywords "nasoalveolar molding," and "presurgical infant orthopedics." A total of 24 out of 51 videos were found to be applicable to this study and rated for quality using the Global Quality Scale (GQS). To determine whether the contents of the selected 24 videos were useful or not, a content usefulness index consisting of 8 parameters was created. The videos were classified according to the usefulness index as low or high content videos. Spearman rank correlation analysis, Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U-tests were used for statistical analysis. The mean GQS score of the 24 YouTubeTM videos on NAM was 2.3 ± 0.8, indicating overall poor quality. In terms of information, videos with high content (29.2%) were less in number than low content videos (70.8%). GQS values were found to be significantly higher in the high content group (P < .01). Regarding the source, video, and audio quality values were significantly higher in the expert group compared to the caregiver group (P < .01), whereas the usefulness index did not differ between groups (P > .05). A significant relationship was found between GQS and usefulness index, audio quality, and video quality (P < .001). YouTube™ videos on NAM were generally inadequate in their content information and poor in quality. Expert videos, showing better audiovisual quality and flow compared to non-expert videos, did not offer higher quality information about NAM considering the usefulness index.

The Perception and Experience of Parents of Children with Cleft Lip and Palate Concerning the Use Pre-Surgical Infant Orthopedics: A Questionnaire-Based Cross-Sectional Survey.

Background: A transitory period prior to the surgical correction of cleft lip and palate (CLP) is associated with adverse impacts, which may require a medical intervention. Pre-surgical infant orthopedics (PSIO) is deemed to reduce the functional and psychological burden, offering a transition until the definite surgical intervention. Aim: To assess the attitude of Iraqi mothers concerning the application and management of pre-surgical orthopedic appliances in children with cleft lip and palate, taking consideration of the mothers’ occupational status. Methods: The cross-sectional study was conducted in the College of Dentistry at Baghdad University from 5 January 2020 to 4 December 2021. A questionnaire form was validated based on existing data related to the assessment of parents’ satisfaction concerning PSIO. Results: A concern related to the impression procedure was reported by a minority of the participants (6.8%) and it was associated mainly to the perceptions of housewives’ vs. working mothers (p < 0.05). The perceived infants’ discomfort during the impression procedure reported at 11.9% was significantly associated with housewives’ status (p < 0.05). In general, the vast majority of respondents considered the impression as being non-invasive (96.6%). Most mothers found no difficulties in following the instructions of the specialist regarding the insertion of the PSIO and/or taping the elastic bands (62.7%). Respondents believed that CLP infants routinely require PSIO treatment. Interestingly, only a minority of mothers performed an Internet search to look for information about PSIO (7%). The majority indicated the PSIO treatment as beneficial for their infant and a substantial proportion of respondents were satisfied with the outcomes of PSIO, encouraging other parents to consent the PSIO treatment. Conclusion: In general, mothers broadly acknowledged the primary concept of PSIO and accepted the proposed treatment, with a positive attitude towards pre-surgical CLP management, regardless their socio-economic status. They seemed to understand well the expected benefits of PSIO, including feeding improvement, normalization of speech, and optimization of future surgical outcomes.

Presurgical Cleft Management of Infants: A Survey of ACPA Approved and International Cleft Palate and Craniofacial Teams.

To characterize the presurgical infant orthopedics (PSIO) and gingivoperiosteoplasty (GPP) protocols across the American Cleft Palate-Craniofacial Association (ACPA) approved and international cleft palate (CP) and craniofacial teams. Cross-sectional survey. ACPA approved and international CP and craniofacial teams. Respondents from 115 out of 215 ACPA approved and international CP and craniofacial teams permitted to contact (out of a total of 259 total teams) completed the survey (response rate = 53.5%). There were 89 (77.4%) ACPA approved teams and the remaining international teams were mainly located in Europe (13.0%). Seventy-eight CP and craniofacial teams (67.8%) provided PSIO and 65 (83.3%) of these teams used alveolar molding (AM). Twenty-two CP and craniofacial teams (19.1%) provided GPP. A mean of 9.5 ± 2.6 different specialists were on the cleft team with the most common being orthodontists (97.4%), speech therapists (96.5%), and plastic/craniofacial surgeons (90.4%). Most ACPA approved and ACPA registered international CP and craniofacial teams provided PSIO techniques by orthodontists using lip taping (LT) and AM, while few provide GPP.

Naso-alveolar molding for newborn cleft lip and palate.

The nasoalveolarmolding (NAM) technique is a relatively new approach to pre-surgical infant orthopedics that reduces the severity of the initial cleft alveolar and nasal deformity before surgery. This technique has proved to be an effective adjunctive therapy for reducing cleft deformity before surgery. Data on NAM are inconsistent with changes in nasal symmetry. However, there is a trend towards a positive effect. Therefore, it is of interest to report clinicians an overview of NAM appliance and method for nasal symmetry assessment to facilitate greater usage of this technique in contemporary practice. Thus, the biomechanics of pre-surgical infant orthopedics and of nasal stent that skillfully shape alveolus and nasal cartilage is explained.

Controversies in cleft lip &amp; palate: A literature review

Orthodontics is the branch where great pioneers exists and they come with varying opinion leading to controversies. Nasoalveolar molding (NAM) is a form of presurgical infant orthopedics (PSIO) whose goal is to reduce the severity of the cleft deformity and improve surgical outcomes. The data on efficacy and benefit of NAM are mixed. Those in favor of NAM report improved nasal symmetry and appearance, reduced overall costs, psychosocial benefit to family, and decreased need for early nasal revision. Those in opposition to NAM argue NAM causes increased caregiver burden, poor patient compliance, increased costs in the short term, relapse of nasal symmetry in the first year, and no conclusive data of improved outcomes. For cleft palate repair controversy exist with timing of cleft repair, each with it’s own advantage and disadvantage with no conclusive results. These two controversies has been discussed here.

Three-dimensional Analysis of Factors Related to the Effective Alveolar Molding in Presurgical Infant Orthopedics: Findings From a Pilot Study.

Presurgical infant orthopedics (PIO) reduces the severity of the original cleft and burden on patients and their parents, provides better esthetics and function, and enables surgeons to achieve better surgical repair. To reduce the alveolar cleft width and to predict treatment difficulty using PIO, various measures were examined in pretreatment cast models. Retrospective case-control pilot study. The patients were 22 infants with non-syndromic unilateral cleft lip and palate (UCLP), and cast models of these infants were used. After PIO using passive plates, infants with UCLP were divided into two groups: contact group (12 cases with close proximity of the greater and lesser segments) and non-contact group (10 cases without proximity of segments). The two groups were compared, and variables related to the proximity between alveolar clefts were examined. There was no significant difference in age at PIO initiation between the two groups. However, the treatment duration was significantly longer in the non-contact group than in the contact group. Among the 13 variables, the initial lateral deviation of the nasal septum was significantly larger in the contact group than in the non-contact group. A significant positive correlation was observed between the initial lateral deviation of the nasal septum and reduction of the alveolar cleft width by PIO. Initial lateral deviation of the nasal septum is a predictive factor for the proximity between alveolar segments in infants with UCLP at the PIO.

Presurgical infant Orthopedics

The cleft lip and palate (CLP) anomaly involves treatment right from birth till adulthood. A lot of treatment modalities are also time and age sensitive, that if not performed at the correct time, the results are sub-optimal or compromised. One such treatment modality is Presurgical Infant Orthopaedics (PSIO) which is among the first corrective and therapeutic procedures performed in the infants with CLP anomaly. The role of an orthodontist is pivotal in guiding the two cleft segments into a relatively normal position before the surgical repair is performed. Over the course of history, this procedure has seen many modifications, arguments over its utility, and counter arguments of the potential harms. The present articles shed light over the initial inception of the procedure, its development and improvement, long-term changes seen in the patients treated with PSIO technique, and finally the latest advancements in technique.