Recent advances in presurgical molding in cleft lip and palate.

PURPOSE OF REVIEW: Although many protocols for treating infants with cleft lip and palate have been successful, the severely wide deformities often require a multidisciplined team approach. Maxillary appliances have been used for 50 years; however, nasal molding is a relatively recent development that has shown progress but not without stalwart criticism.

RECENT FINDINGS: Presurgical nasal alveolar molding is an evolving technique in the treatment of cleft lip and palate. Used properly, molding can create improved nasal symmetry in unilateral cases and columellar lengthening in bilateral cases. Some regression of improvement is often seen in the following years due to differential growth patterns within the nasal subunits. The nasal septal and columellar deviation seen in unilateral cleft lip and palate can also be improved with a novel device.

SUMMARY: Although traditional repair of the cleft lip and nasal deformity is often adequate, severely wide clefts are amenable to a variety of presurgical measures. Presurgical nasal alveolar molding in children with cleft lip and palate allows repositioning of the maxillary alveolus and surrounding soft tissues in hopes of reducing wound tension and improving results. These techniques can be extremely challenging but an excellent addition to a cleft lip and palate team's armamentarium.