Presurgical Infant Orthopedics: Sustainable Alternatives to Nasoalveolar Molding.

The conventional management of cleft patients involves presurgical infant orthopedics (PSIO), a strategy designed to align maxillary segments and improve nasal shape before definitive reparative surgery. Nasoalveolar molding (NAM) has been widely adopted for this purpose, but its drawbacks are threefold: it is costly and unavailable in many low-income countries and requires frequent follow-up. The aim of this article is to present practical PSIO alternatives that offer greater accessibility and sustainability while yielding comparable preoperative outcomes. The authors propose that the suggested approaches, categorized as either nasal elevator-based or nostril retainer-based methods, are suitable for centers lacking orthodontic infrastructure and should be integrated into global cleft care protocols.