Background <p>Bilateral cleft lip and palate is a severe orofacial anomaly associated with wide alveolar defects and complex nasal deformities. Surgical repair of such a defect is challenging and increases the risk of compromised esthetic and functional outcomes. Early presurgical nasoalveolar molding (PNAM) is a non-surgical orthopedic technique used to reduce cleft severity and improve nasal form prior to surgical repair. This case demonstrates the tangible clinical benefits of early intervention in optimizing surgical conditions and outcomes in a complex bilateral cleft presentation.</p> Case presentation <p>A 20-day-old Indian male infant with complete bilateral cleft lip and palate underwent PNAM therapy using a custom intraoral molding plate with a nasal stent and lip taping. Therapy was continued for 4&#xa0;months, resulting in a reduction in alveolar cleft width from 11 to 5&#xa0;mm and improvement in nasal morphology. Primary bilateral cheiloplasty was performed at 5&#xa0;months of age, followed by palatoplasty at 11&#xa0;months. Postoperative healing was satisfactory, with improved feeding and age-appropriate speech development.</p> Conclusions <p>Early PNAM therapy in infants with BCLP substantially reduces alveolar defect size, improves nasal morphology, and facilitates optimal outcomes, supporting its role as an important adjunct in comprehensive cleft management.</p>