PRESURGICAL ORTHOPEDICS IN THE SURGICAL-MANAGEMENT OF UNILATERAL CLEFT-LIP AND PALATE

Forty years after its introduction by McNeil and Burston, presurgical orthopedics remains a controversial subject. Although the more extrava gant claims for the technique have been dismissed, assessment of its p roper place in cleft rehabilitation has been hampered by the poor desi gn of early studies. Furthermore, although the principles of presurgic al orthopedics are derived from the venerable tradition of reducing cl eft width to facilitate reconstructive surgery, almost all research ha s focused on matters of dental alignment, cross bites, and maxillary a rch form. Not one research paper has ever been published investigating the possible benefits to cleft surgery resulting from presurgical ort hopedic treatment. Although it is now generally accepted that presurgi cal orthopedics does not give significant orthodontic benefits, there are still numerous opinions indicating that presurgical orthopedics do es facilitate primary reconstructive surgery for cleft lip and palate. Furthermore, presurgical alignment of the maxillary skeletal base is considered essential to some of the new techniques of primary rhinopla sty.