Published onIn Utero Insights
One of the most important advances in the care of cleft lip and palate in the last 30 years is nasoalveolar molding (NAM). Children’s Hospital of Philadelphia is one of only a few institutions in the country to offer this state-of-the-art treatment.
NAM is a presurgical therapy used to reduce the severity of the cleft before surgical repair. The skin and cartilage of an infant’s face are very moldable. The NAM procedure takes advantage of this flexibility to modify the baby’s face in a way that decreases the width of the cleft of the lip and gums (alveolus), improves gum alignment, and helps improve the shape of the nose. Patients who undergo NAM tend to have better, more predictable results after surgical cleft lip and nose repair, and need fewer revisional surgeries later in life. This treatment is indicated for patients with complete unilateral or bilateral clefts of the lip and palate, but also can help with improving nasal shape in less severe incomplete clefts of the lip.
For families that elect to have their child undergo NAM therapy, care in our Nasoalveolar Molding Program begins within the first few weeks of life. Each NAM device is custom made. Our orthodontists use a type of dental putty material to make an impression of the child’s palate. This impression is then used to make an acrylic mouthpiece (also called the molding appliance) that covers the roof of the child’s mouth. This mouthpiece restores the boundary between the mouth and nose cavities and protects the child’s delicate nasal tissues from the rough surface of the tongue. The mouthpiece can also provide a solid surface against which a child can compress a bottle’s nipple.
The mouthpiece is held in place by small rubber bands that are taped to the child’s cheeks. It is gradually adjusted to bring the gum and lip segments closer together. When the gaps between the lips and gums (alveolar gap) are much smaller, a nasal stent, which is a small supportive extension made of orthodontic wire and soft dental material, is added to the mouthpiece to lift and gently reshape the nasal cartilage.
The molding process requires weekly follow-up visits for adjustments over the course of about three to six months until the child is ready for surgery to repair the cleft lip. During the weekly follow-up meetings, our expert team evaluates the child’s feeding and weight gain. These weekly check-ins provide comfort to parents during a time of anxiety and offer a place where their questions and concerns can be addressed.
Cleft and craniofacial team orthodontic care in the United States: A survey of the ACPA. Khavanin N, Jenny H, Jodeh DS, Scott MA, Rottgers SA, Steinberg JP. Cleft Palate-Craniofac J. 2019;56(7):860-866.
Presurgical dentofacial orthopedic management of the cleft patient. Smith KS, Henry BT, Scott MA. Oral Maxillofac Surg Clin North Am. 2016;28(2):169-176.