Comparison of Two Presurgical Orthopedic Protocols in Unilateral Cleft Lip and Palate

Introduction: Sixteen non-syndromic patients with complete unilateral cleft lip and palate and cleft width greater than 6 mm were evaluated retrospectively to compare 2 presurgical orthopedic protocols at a single center: treatment with a passive orthopedic appliance (POA) in conjunction with the novel Rhinoplasty Appliance System (RAS; Group 1), or treatment with traditional naso-alveolar molding (Group 2). Methods: Photographic and cast records were assessed. Photographic measurements included facial midline to nasal tip angle, cleft width to inter-commissural distance ratio, columellar deviation angle, nostril dimension ratios, and columellar height ratio. Cast measurements included maxillary cleft width, arch width, and anteroposterior length. Results: Both groups (Group 1, n = 7; Group 2; n = 9) showed significant improvements. Cleft width decreased markedly in Group 1 (9.4 ± 2.0 mm → 1.4 ± 0.4 mm) and Group 2 (10.8 ± 2.9 mm → 4.8 ± 1.7 mm). Arch width showed a slight reduction, while anteroposterior arch length increased in both groups. Nasal measurements demonstrated notable improvements: the facial midline–nasal tip angle decreased (Group 1: 25.2° → 8.9°, Group 2: 24.1° → 12.6°), columellar deviation angle increased (Group 1: 39.0° → 72.2°, Group 2: 35.5° → 58.9°), and columellar height ratio increased (Group 1: 0.1 → 0.9, Group 2: 0.2 → 0.7). Nostril symmetry also improved in both groups. Overall, both treatments reduced cleft width and improved nasal form, with slightly greater correction in Group 1. Conclusion: Both protocols reduced cleft width and improved nasal symmetry. Group 1 had a greater reduction of the cleft width and facial midline to nasal tip angle, a greater increase in columellar deviation angle and columellar height ratio, and a greater decrease in the nostril width ratio. While both protocols can improve the form of the lip and nose, the novel RAS, which decouples nasoseptal alignment from alveolar molding, offers potential advantages.