Cleft Lip and Palate Treatment Modalities

Cleft lip and palate repair encompasses a spectrum of surgical and non-surgical interventions designed to restore form and function to the orofacial region. Primary surgical repair typically occurs within the first year of life and aims to achieve watertight closure of the lip and palate, optimise speech development and normalise facial growth. Presurgical orthopaedic techniques, such as nasoalveolar moulding and passive palatal plates, are employed to reduce cleft width, align alveolar segments and shape nasal cartilages before definitive surgery. Advances in digital technology have introduced computer-aided design and manufacturing workflows to fabricate patient-specific appliances, improving precision, safety and accessibility. Three-dimensional imaging modalities, including cone-beam computed tomography and stereophotogrammetry, have enhanced preoperative planning and postoperative assessment. Multidisciplinary care pathways integrate paediatric dentistry, orthodontics, speech therapy and psychosocial support to address feeding, hearing and developmental concerns. Centralisation of services and standardised protocols have been shown to improve consistency of outcomes and facilitate long-term evaluation of facial growth, speech intelligibility and dental arch relationships. Together, these modalities reflect a global trend towards evidence-based, technology-driven and patient-centred cleft care.

Research from Nature Portfolio

Recent studies have focused on refining presurgical nasal and alveolar correction through image-guided appliance fabrication. A 2023 investigation demonstrated that two-dimensional photographs can be translated into custom three-dimensional nostril retainers, enabling postoperative nasal stenting without frequent hospital visits and reducing overall treatment cost. This approach relied on digital image analysis to measure nostril dimensions within a 2 mm margin of error and employed additive manufacturing to produce individualised retainers. An earlier prospective analysis of a two-stage nasoalveolar moulding protocol provided dense three-dimensional scanning data to quantify weekly morphological changes in unilateral cleft lip and palate infants. This work revealed that the majority of nasal and alveolar alignment occurs in the initial phase of treatment, underscoring the importance of early intervention and standardised adjustment schedules.

Cleft Lip and Palate Treatment Modalities publication trend

The graph below shows the total number of articles in cleft lip and palate treatment modalities across all publications each year (not limited to Nature Index journals).

Technical terms

Nasoalveolar moulding (NAM): A presurgical orthopaedic technique that gradually repositions alveolar segments and reshapes nasal cartilages using customised intraoral and nasal stents.

Presurgical orthodontic palatal plate: A passive acrylic appliance fitted to the maxillary arch of neonates to stabilise alveolar ridges and facilitate subsequent surgical repair.

CAD/CAM: Computer-aided design and computer-aided manufacturing technologies used to create precise, patient-specific surgical and orthodontic appliances.

Cone-beam computed tomography (CBCT): A three-dimensional imaging modality that provides volumetric data of craniofacial structures with lower radiation dose than conventional CT.

Cephalometric analysis: Quantitative assessment of skull and facial relationships using lateral or frontal radiographs to guide orthodontic and surgical planning.

References

1. Complete Digital Workflow for Manufacturing Presurgical Orthodontic Palatal Plates in Newborns and Infants with Cleft Lip and/or Palate. Journal of Functional Biomaterials (2024).
2. Utilization of images and three-dimensional custom-made nostril retainer fabricate for patients with cleft lip and cleft lip nose deformities at Siriraj Hospital: preliminary phase. Scientific Reports (2023).
3. The role of Nasoalveolar molding: A 3D Prospective analysis. Scientific Reports (2017).
4. Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review. PLOS ONE (2014).
5. Craniofacial Cephalometric Morphology in Caucasian Adult Patients with Cleft Palate Only (CPO). Diagnostics (2023).
6. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics. BMC Health Services Research (2012).
7. Centralization of cleft care in the UK. Part 6: a tale of two studies. Orthodontics and Craniofacial Research (2015).