Effectiveness of Presurgical Orthopedic Interventions in Infants With Unilateral Cleft Lip and Palate: A Systematic Review and Network Meta-Analysis

Objective To assess the effects of different Presurgical Orthopedic (PSO) appliances on alignment of alveolar segments and nasal morphology in infants with unilateral cleft lip and palate. Methodology A comprehensive electronic search was performed across health science databases up to March 23, 2025, supplemented by manual searching, gray literature, and unpublished material, following PRISMA guidelines. Study quality was evaluated using ROBINS-I (Risk Of Bias In Nonrandomized Studies—of Interventions) and Cochrane RoB 2 (risk-of-bias) tools. Included studies were randomized controlled trials (RCTs) or non-RCTs involving infants with unilateral cleft lip and palate treated with PSO techniques, focusing on alveolar segment alignment and nasal morphology. Quantitative data were analyzed through a Frequentist network meta-analysis (NMA) using Python and meta-insight software to compare the effectiveness of different PSO interventions. Results Twenty-one studies (9 RCTs, 8 prospective, and 4 retrospective) were included. The network meta-analysis revealed that Grayson's NAM achieved the greatest reduction in alveolar gap width [– 10.00 (95% confidence interval (CI) −12.22; −7.78)]mm while the Figueroa presurgical nasoalveolar molding technique showed the most improvement in columella angle (17.50, 95% CI [6.61, 28.39]) degrees followed by Dynacleft with Nasal elevator [15.34, 95% CI (−0.07, 30.75)] degrees from the baseline. Conclusion All PSO techniques demonstrated improvements in alveolar cleft width reduction and columella angle enhancement, with the Grayson technique for alveolar cleft width reduction and the Figueroa technique and Dynacleft with Nasal elevator technique for columella angle, being more effective than the others without being statistically different. PROSPERO Registration number: CRD42025632490