Impact of three types of presurgical infant orthopedics on nasolabial appearance in unilateral cleft lip and palate: a 4-year follow-up study

Objectives: To evaluate the impact of presurgical infant orthopedics (PSIO) on nasolabial appearance among three PSIO methods (modified Grayson's technique, DynaCleft nasal elevator, OrthoAligner NAM with DynaCleft nasal elevator) and no-PSIO in children with unilateral cleft lip and palate (UCLP) at 4 years' follow-up. Materials and Methods: This study took place in an academic and a peripheral center at which patients with UCLP were treated and followed. A total of 48 patients with UCLP were divided into four groups of 12 patients each. Group 1 underwent PSIO using modified Grayson's technique. Group 2 received PSIO incorporating DynaCleft nasal elevator. Group 3 treatment involved OrthoAligner NAM in combination with DynaCleft nasal elevator, whereas Group 4 did not receive any form of PSIO. Asher-McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS) were used to assess nasolabial appearance 4 years post-lip surgery (mean age: 4.3 years ± 6 months) on standardized photographs of the nasolabial region. Kruskal-Wallis test was used to assess nasolabial appearance scores among treatment groups. Results: Nasolabial appearance showed no significant differences between PSIO and no-PSIO groups across facial esthetic indices regarding nasal form (P = .819), deviation of the nose (P = .403), shape of the vermillion border (P = .801), nasal profile including upper lip (P = .726), nose (P = .973), and lips (P = .72). Conclusions: In patients with UCLP, there was no significant difference in nasolabial appearance 4 years after lip repair when comparing three different PSIO modalities to no-PSIO group.