Presurgical orthopedic management in cleft lip and palate: a comparative analysis

Abstract

Introduction: Cleft lip and/or palate is the most common congenital craniofacial malformation. Successful treatment requires a comprehensive, multidisciplinary, and personalized approach from birth. Infant presurgical orthopedics (IPO) are essential to the treatment process, as they combine strategies that guide maxillary growth, improve nasal symmetry, reduce cleft width, and facilitate surgical closure. Literature indicates that the ideal time to begin IPO is between the first week and the fourth month of life. Case Report: this report presents two cases of patients treated at Fundación Hospital de la Misericordia (HOMI) by the postgraduate program in Pediatric Stomatology and Maxillary Orthopedics of the Universidad Nacional de Colombia. The first male patient began treatment at one month of age for a complete unilateral right cleft lip and palate (L+PH). The second male patient, with a complete unilateral right cleft lip and palate, began IPO treatment at 5months of age. In both cases, nasoalveolar molding was performed using an obturator plate with nasal stents and lip taping, adapted to the clinical characteristics of each patient. Conclusion: The morphometric comparison shows that early IPO initiation leads to better patient adaptation, reduced cleft size, improved aesthetics, and greater ease for surgical repair. although delayed treatment remains a viable option with acceptable outcomes, these findings highlight the importance of early intervention during the first weeks of life.