DOI: 10.4103/jdmimsu.jdmimsu_43_24 ISSN: 0974-3901

Pioneering Pediatric Orthopedics: Redefining Classification for Bilateral Cleft Lip and Palate in Infants Assisted with Presurgical Intervention

Pallavi S. Daigavane, Priyanka Niranjane, Bhagyashri Chimote, Kshitij Bang
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Introduction:

After clubfoot, the most common congenital deformity is cleft lip with or without palate. Over the years, various treatment modalities and protocols have been formulated for these patients so as to achieve a satisfactory outcome. McNeil (1950) and Burstone (1958) were the pioneers of presurgical infant orthopedics; many researchers enhanced their notion by changing the basic design of the device of the appliance. It was Matsuo et al . (1989) who described the moldability and plasticity of neonatal nasal cartilage within 2 weeks of an infant’s life. Grayson et al . (1990, 1999) suggested a new technique of presurgical nasoalveolar molding for approximating the alveolar segments to reduce nasal deformity using Matsuo’s concept. This procedure has sparked a lot of attention and is now being utilized as an alternative to standard techniques of treating infants with cleft malformations. The anatomies and treatment objectives differed between unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) cases. As a result, using a single procedure for all sorts of cleft instances would be inappropriate. Hence, it is necessary to classify children with UCLP and BCLP in order to personalize the presurgical intervention orthopedics (PSIO) operation and reap the benefits mentioned. The purpose of this study is to propose a revised classification method for infants with BCLP in order to support PSIO.

Aim and Objective:

To develop a new classification system for the infants with Bilateral Cleft Lip and Palate to be treated with Presurgical infant orthopedics with an objective to assist in alveolar and nasal molding with judicious selection of the cases for the PSIO to avail the documented advantages of PSIO.

Methodology:

Post lip and patalal repair cast of the infants with BCLP treated with PSIO were assessed for the growth of maxilla from the records under Smile Train. They were assessed for the length of alveolar segment, cleft defect size, AP and transverse dimensions. Amongst the wide variety of the anatomical variation total 8 types were finalized and accordingly biomechanics is suggested.

Result:

(a) Easy to understand and implementation. (b) To provide information about variations in BCLP cases. (c) To ease the selection of appropriate treatment modality.

Conclusion:

This study introduces a novel classification system for infants with cleft lip and palate, emphasizing the importance of tailored interventions for BCLP cases. The results underscore the practical benefits of the classification system, offering a valuable tool for clinicians to optimize PSIO procedures and enhance outcomes in cleft lip and palate management.

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