Endeavors to Optimize Cleft Surgical Outcomes: A History of Presurgical Appliances

Throughout history, efforts to optimize outcomes in cleft lip and palate treatment have evolved significantly. Presurgical infant orthopedic appliances have become essential in reshaping and aligning cleft segments before surgical repair, improving both function and aesthetics. Dating back to the 15th century, these devices were designed to minimize the size of the cleft, thereby facilitating a more precise surgical repair. The advent of nasoalveolar molding and similar techniques aim to reduce the need for extensive secondary surgeries, minimize scar tissue formation, and improve nasal symmetry. While benefits have been noted, the use of presurgical appliances varies worldwide, reflecting differences in healthcare resources, expertise, and cultural perspectives on cleft management. Notably, although early origins trace back centuries, modern presurgical orthopedics were pioneered by McNeil in the 1950s, marking the beginning of contemporary appliance-based cleft preparation. This article explores the historical milestones, types of appliances, clinical benefits, and the controversies surrounding their use, offering a comprehensive understanding of how these tools impact patient outcomes.