Cleft Presurgical Infant Orthopedics: Evolution from Analog to Digital Appliances—Will It Increase Accessibility?

In the present day, presurgical infant orthopedic (PSIO) treatment is routinely implemented by cleft providers to reduce the space between cleft segments before surgical repair as well as to address the coexisting cleft nasal deformity. Since the inception of PSIO treatment, various modifications in both appliances and techniques have developed to improve treatment efficiency, postoperative outcomes, and access. Early PSIO appliances solely addressed alveolar malformations. In the early 1990s, Grayson introduced and popularized the technique of nasoalveolar molding. Following the device and protocol developed by Grayson, successive appliances, such as the modification introduced by Figueroa, have mitigated the risk of complications. Currently, advancements in 3-dimensional technology have revolutionized presurgical cleft care with increased treatment accuracy, efficiency, and reproducibility. Modern PSIO devices have harnessed 3-dimensional technology, including growth and treatment simulation through time, and can play a critical role in increasing accessibility of care in low- and middle-income countries. Nongovernmental organizations such as Smile Train operate to deliver comprehensive cleft care to low- and middle-income countries while helping develop local and national initiatives to create sustainable solutions. In collaboration with national and local health authorities and providers, as well as private industry, nongovernmental organizations can continue to work toward providing sustainable, high-quality comprehensive cleft care across the globe.