"Comparative Effectiveness of PLANA and Nasal Elevator in Presurgical Orthopedics: A 3D Anthropometric Study of Unilateral Cleft Lip.".

BACKGROUND

As limitations of nasoalveolar molding (NAM), including labor intensity and reliance on specialized expertise and infrastructure, have become increasingly evident, interest has shifted toward simplified presurgical infant orthopedics (PSIO). Nasal Elevator (NE)-based protocols and the recently introduced Presurgical Lip-Alveolus-Nose Approximation (PLANA) represent such alternatives. However, these two simplified approaches have not been directly compared using objective three-dimensional analysis and a validated anthropometric grading system. This study compared NE-based PSIO and PLANA in infants with unilateral cleft lip.

METHODS

Consecutive cohorts of 26 infants treated with NE (2023-2024) and 23 infants treated with PLANA (2024-2025) were analyzed; all PSIO was performed by the same surgeon. Cleft severity (four levels) and PSIO outcomes (Excellent/Good/Poor) were assessed using a validated anthropometric grading system based on nostril width ratio (NWR), columellar angle (CA), and subnasale lateral displacement (SN). Groups were compared using Fisher's exact test, chi-square testing, and Mann-Whitney U test (p < 0.05).

RESULTS

Baseline characteristics were comparable between groups. PLANA achieved a more favorable post-PSIO severity distribution (p = 0.049) and a higher proportion of Excellent outcomes with fewer Poor outcomes (χ² = 7.48, p = 0.024). Improvement in SN was significantly greater with PLANA (p = 0.04), whereas improvements in NWR and CA were comparable between techniques.

CONCLUSIONS

Both NE-based PSIO and PLANA improved nasolabial morphology in unilateral cleft lip. However, PLANA demonstrated superior presurgical orthopedic effectiveness, particularly in subnasale alignment, supporting its role as an effective and scalable PSIO strategy.