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 extravagant claims for the technique have been dismissed, assessment of its proper place in cleft rehabilitation has been hampered by the poor design of early studies. Furthermore, although the principles of presurgical orthopedics are derived from the venerable tradition of reducing cleft width to facilitate reconstructive surgery, almost all research has focused on matters of dental alignment, cross bites, and maxillary arch form. Not one research paper has ever been published investigating the possible benefits to cleft surgery resulting from presurgical orthopedic treatment. Although it is now generally accepted that presurgical orthopedics does not give significant orthodontic benefits, there are still numerous opinions indicating that presurgical orthopedics does 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 rhinoplasty.