Nasoalveolar molding (NAM) is a surgical preparation therapy that may be indicated for infants born with cleft lip and palate. The goal of NAM is to reduce the severity of the oronasal cleft deformity prior to surgical repair by gradually closing the gaps in the lip and alveolus (gums), and shaping the nose to restore anatomical form and symmetry.
NAM therapy utilizes the increased elasticity of the cartilaginous tissues during the neonatal period to prepare your child for surgery with the aim of improved surgical results.
If indicated, NAM therapy starts within the first few weeks of life and will continue until your child is ready for cleft lip repair. This can range from 3 to 6 months of age depending on the severity of the cleft.
The technique employed at CHOP utilizes an acrylic plate, similar to a retainer, which covers the roof of your baby’s mouth. It is custom made for each patient and, in conjunction with medical tape applied to your child’s cheeks, will guide the growth of the gums to gradually close the cleft.
When the alveolar gap is sufficiently reduced, a nasal stent made of orthodontic wire and dental acrylic is added to the plate to lift and shape your baby’s nose. Careful adjustments are made to the nasal stent to gradually restore the nose to a more symmetrical and anatomical form. By bringing the lip and alveolar segments together and restoring the form of the nose prior to surgical repair, NAM allows your child’s surgeon to repair the cleft with minimal tension.
In the first few weeks of life, we will take an impression of your child’s palate that will be used to make the molding appliance. An orthodontist certified in nasoalveolar molding will place the device in your child’s mouth and review with you how to care for the appliance at home.
Over the next 3 to 6 months, we gradually adjust the acrylic plate, nasal stent and tapes to bring the gum and lip segments closer together and gently mold the nose. This process requires weekly follow-up visits for adjustments until your child is ready for surgery to repair the cleft lip.
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 appliance clean. Our team will provide advice and guidelines on how to care for your baby at home.
Patients who undergo NAM tend to have better results when it comes time for surgical repair. By the end of treatment, the plate is removed and the nose is aligned to be more symmetrical. The gradual process of bringing the lip and alveolar (gum) segments together prepares the lips, gum and palate for surgical repair.
The next step after lip repair is cleft palate repair, which is also performed by your child’s plastic surgeon. The goal of cleft palate surgery is to fix the roof of the mouth so that your child can eat and talk normally. Cleft palate surgery is generally performed around 12 months of age. Learn more about cleft palate repair.
Updated January 2014