Neonatal maxillary orthopedics: past to present

Neonatal maxillary orthopedics was introduced in the treatment protocol for cleft lip and palate in the 1950s of the last century. A wide range of appliances has been designed with pin-retained active appliances at one end of the spectrum and passive appliances at the other. Although neonatal maxillary orthopedics originally was instituted to restore the normal anatomy and to guide growth and development of the maxillary segments, later on, many other unproven benefits were claimed. Based on the results of a randomized clinical trial into the effects of infant orthopedics performed by means of passive plates (DUTCHCLEFT), we conclude that neonatal maxillary orthopedics in unilateral cleft lip and palate patients as performed in this trial is not necessary for feeding, mothers’ satisfaction, or orthodontic and surgical reasons. Regarding speech, a positive but very limited effect was found until the age of 2-1/2 years, but the speech of the children with clefts remained far behind that of their non-cleft peers anyway. However, it is questionable whether this limited effect is important enough to justify neonatal orthopedics. The most recent type of neonatal maxillary orthopedics is nasoalveolar molding. In NAM, nasal stents are added to the alveolar molding plate. The appliance aims to improve nasal tip projection, and septal and lower lateral cartilage position, before cleft repair. In bilateral cleft lip and palate, the nasal stents can be used to gradually lengthen the deficient columella. However, so far, NAM suffers from lack of scientific evidence for its application.