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Our craniofacial orthodontic team specializes in techniques that can decrease the severity of an infant’s cleft lip and nose before surgery. This makes the surgery quicker and more reliable.
What is Nasoalveolar Molding?
Nasoalveolar moldings involves the use of a custom made orthodontic appliance to reduce the severity of the cleft before the first surgery on the lip. Our craniofacial orthodontist did a full fellowship with the inventors of NAM and has over 15 years of experience in treating babies with this amazing technique.
The goal of NAM is to reduce the size of the cleft at the level of the lips and gums and improve the shape of the nose before surgery. The appliance works by slowly decreasing the width of the cleft of the lip and gums. This results in improved alignment of the gums and helps to improve the shape of the nose. This preparation has been shown to help improve surgical results.
The skin and cartilage of an infant's face are very flexible in the first few months of life. This allows the orthodontist to change the position of the gums, lip and shape of the nose in preparation for surgery.
NAM treatment ideally starts in the first few weeks after a baby with a cleft is born and continues until the child is ready for cleft lip repair. It can begin as soon as we know that the baby is feeding well and gaining weight. Treatment time depends on the severity of the child’s cleft. Average treatment time is 3 to 4 months for a baby with a cleft lip on one side (unilateral cleft) and 4 to 5 months with a cleft on both sides (bilateral cleft).
Nasoalveolar molding starts with our team teaching you how to apply gentle molding forces across your baby’s cleft using tape and small elastic bands. Once you are comfortable with applying the tape, we will take a mold impression of the infant’s mouth. The mold is then used to make a NAM appliance that fits your baby perfectly. It is an acrylic plastic mouthpiece that covers the roof of your child’s mouth. It is like a retainer that is used by teenagers after braces are removed. This mouthpiece separates the mouth and nose cavities and protects your child's delicate nasal tissues from the rough surface of the tongue. The mouthpiece can also help your child feel better because it provides a solid surface against which the feeding bottle nipple may be pressed.
Each NAM device is custom made and is held in place by small rubber bands that are taped to your child's cheeks. Initially, the appliance is adjusted every one or two weeks to guide natural growth to narrow the clefts of the lips and gums.
When the gaps between the lips and gums (alveolar gap) are much smaller, a small supportive extension to the mouthpiece is added to lift and shape the nose. The extension (also called a nasal stent) is made of orthodontic wire and soft dental material. The nasal stent is gradually adjusted to restore the shape of the nose. While the nose is being shaped, the visits for adjustments may be reduced to once every 3 weeks.
By bringing the lip and gum segments together and restoring the shape of the nose before surgery, NAM can contribute to a better outcome. You will be satisfied knowing that you have contributed directly to your child’s cleft care. Children with cleft lip and palate who are treated with NAM typically require fewer surgeries than those who do not receive nasoalveolar molding treatment.
How does NAM work?
If your child is a good candidate for NAM and you elect to move forward with treatment, a putty material is used to make an impression of the roof of the mouth. The mold is then used to make the molding appliance. The orthodontist, who is trained to perform nasoalveolar molding, will place the appliance in your child’s mouth and review with you how to care for the appliance at home. The appliance is generally used full-time. Many parents report the appliance is well-tolerated and feeding becomes more efficient. If the baby is not able to feed well with the appliance as they are getting used to the device, it may be removed to allow for a feed and replaced after feeding.
Over the next 3 to 6 months, our specialist team will gradually adjust the appliance device by adding and removing some of the acrylic plastic. Lip tape will be used in combination with the appliance to bring the gum and lip segments closer together and the nasal stent(s) will be used to gently mold the nose. Initially, this requires weekly or every other week follow-up visits for adjustments; once the nasal stents are added to the appliance, the frequency of the visits may be decreased to every 3 to 4 weeks, until your child is ready for surgery to repair the cleft lip.
Is it hard to learn how to help my baby with NAM?
Nasoalveolar molding requires commitment and teamwork from parents and families. You become an important part of your child’s care team by changing the medical tape daily and keeping the mouthpiece clean. Although parents can sometimes be nervous when they are first learning the technique, you will quickly become an expert and enjoy seeing the positive changes you are creating in their child’s cleft. Our team will teach you how to care for your child at home and will answer any questions you may have. We will always be available to answer any questions you have as you learn NAM over the phone or by MyChart messaging. We can also see you and your infant in clinic the next business day for any appliance adjustments. It is OK for you to remove the NAM device if you are having problems, and then come to clinic the next day to have our team help find a solution.
Results of NAM
Patients who undergo NAM tend to have better results when it comes time for surgical repair. By the end of treatment, the nose is better aligned and more symmetrical and there is more lift of the nostril(s). The gradual process of bringing the lip and gum segments together makes the cleft narrower and prepares the lips, gum and palate for surgical repair. Surgeons report that there is less tension on the lip repair, and less surgery is needed on the nose and cheeks in babies that have had NAM.
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