Treating Cleft Lip And Palate With NasoAlveolar Molding

October 23, 2012

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Cleft lip and palate is a congenital malformation effecting the bones, teeth, soft tissues and musculature of the middle portion of face. Treatment for cleft lip and palate requires correct timing and coordination of treatment between a team of health professionals, including plastic and reconstructive surgeons, orthodontists, pediatric dentists and otolaryngologists. NasoAlveolar Molding (NAM) is a treatment procedure usually performed by a dental profession prior to the time the plastic and reconstructive surgeon performs the primary cleft lip and nose repair.

Prior to the 4th week of pregnancy the middle portion of face is comprised of several individual units. Between the 4th and 10th week of pregnancy these units fuse and form the completed middle portion of the face. In cleft lip and palate the process of fusion does not occur properly, resulting in clefts. As development continues during pregnancy these clefts allow portions of the upper jaw and nose to becomes displaced and abnormally shaped. NasoAlveolar Molding (NAM) corrects the abnormal position and shape of the upper jaw and nose prior to the primary lip and nose repair.

Cleft lip/palate before and after NasoAlveolar MoldingStarting as early as 2 weeks of age, an individually custom designed plate, similar to a denture with no teeth, is used to progressively mold the displaced upper jaw segments into their proper location. During treatment a nasal stent is also added to this plate that reshapes the malformed nasal cartilages. NasoAlveolar Molding (NAM) is effective due to the unique moldable characteristics of an infant’s bones and cartilage. Weekly adjustments are made until the baby is ready for their primary lip and nose repair.

By performing NasoAlveolar Molding (NAM) the plastic and reconstructive surgeon is faced with a less complex primary lip and nose repair, the lip repair is under less tension after the surgery leading to less prominent scaring, and nasal esthetics can be significantly improved.

NasoAlveolar Molding (NAM) was developed by a craniofacial orthodontist, Dr Barry Grayson, in close collaboration with a plastic reconstructive surgeon, Dr Court Cutting. During my year-long craniofacial orthodontic fellowship I had the privilege of be trained by these 2 world-renowned leaders in cleft care. At Texas Children’s Hospital our cleft team is proud to be able to deliver the highest level of cleft care, including NasoAlveolar Molding (NAM).

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