Effectiveness of Presurgical Orthopedic Interventions in Infants With Unilateral Cleft Lip and Palate: A Systematic Review and Network Meta-Analysis.
Mrudula Desale, Rigzin Tamchos, Aditi Kapur et al.
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In 30 seconds
This systematic review and frequentist network meta-analysis compared presurgical orthopedic appliances for alveolar segment alignment and nasal morphology in infants with unilateral cleft lip and palate. It included 21 studies: 9 randomized controlled trials, 8 prospective studies, and 4 retrospective studies. All techniques were associated with reduced alveolar cleft width and improved columella angle. Grayson’s nasoalveolar molding achieved the greatest reported reduction in alveolar gap width, at -10.00 mm (95% CI -12.22; -7.78), while the Figueroa technique showed the greatest reported improvement in columella angle, at 17.50 degrees (95% CI [6.61, 28.39]).
Key findings
- Grayson’s nasoalveolar molding had the greatest reduction in alveolar gap width: -10.00 mm (95% CI -12.22; -7.78).
- The Figueroa technique showed the greatest columella-angle improvement: 17.50 degrees (95% CI [6.61, 28.39]).
- Dynacleft with Nasal elevator improved columella angle by 15.34 degrees (95% CI (-0.07, 30.75)) from baseline.
- The review reports that the leading techniques were not statistically different from other techniques.
Why it matters
Presurgical orthopedic appliances are used to address alveolar segment alignment and nasal morphology in infants with unilateral cleft lip and palate. This synthesis compares several approaches and identifies techniques with the largest reported changes for each outcome, while indicating that differences between techniques were not statistically significant. The findings help frame the comparative evidence without establishing a clearly superior appliance.
What to keep in mind
The evidence combined randomized and nonrandomized studies, including prospective and retrospective designs, which may limit the certainty of comparisons.