Nasoalveolar Molding

What is nasoalveolar molding?

Nasoalveolar molding (NAM) is a presurgical therapy that may be used to prepare children born with cleft lip and palate for surgery.

The goal of NAM is to reduce the size of the cleft deformity of the lip, gum and nose (oronasal deformity) before surgical repair. NAM gradually decreases the width of the cleft of the lip and gums (alveolus), improves gum alignment, and helps to improve the shape of the nose. This preparation can help improve surgical results.

The skin and cartilage of an infant's face are very flexible. It is this flexibility that allows nasoalveolar molding therapy to work.

NAM therapy begins within the first few weeks of life and continues until your child is ready for cleft lip repair. It can begin as soon as we know that your child is eating well and gaining weight. Treatment time depends on the severity of your child's cleft. Average treatment time is 3 to 6 months.

Nasoalveolar molding starts with an acrylic mouthpiece that covers the roof of your child’s mouth. It is similar to a retainer that children use after their dental braces are removed. This mouthpiece restores the boundary between the mouth and nose cavities and protects your child's delicate nasal tissues from the rough surface of her tongue. The mouthpiece can also help your child feel better because it provides a solid surface against which she may press her bottle's nipple.

Each mouthpiece is custom made and is held in place by small rubber bands that are taped to your child's cheeks. Over time, the mouthpiece will be adjusted to guide your child's natural growth to narrow the clefts of the lips and gums and gradually close the cleft.

When the gaps between the lips and gums (alveolar gap) are much smaller, we will add a small supportive extension to the mouthpiece to lift and shape your child's nose. The extension (also called a nasal stent) is made of orthodontic wire and soft dental material. We will carefully adjust the extension to gradually restore the shape of the nose.

By bringing the lip and gum segments together and restoring the shape of the nose before surgery, NAM can contribute to better outcomes. Children with cleft lip and palate who are treated with NAM typically require fewer surgeries than those who do not receive nasoalveolar molding treatment.

Watch the video to hear pediatric plastic surgeons and a craniofacial orthodontist describe how nasoalveolar molding can improve outcomes for children with cleft lip and palate.

What to expect

If NAM is an appropriate therapy for your child, we will use a type of putty to make an impression of your child’s palate. This will be used to make the mouthpiece (also called the molding appliance). An orthodontist specially trained to perform nasoalveolar molding will place the mouthpiece in your child’s mouth and review with you how to care for the appliance at home.

Over the next 3 to 6 months, your child's doctor will gradually adjust the mouthpiece, nasal extension 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.

Caring for your child at home

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. Our team will teach you how to care for your child at home and will answer any questions you may have.

Results

Patients who undergo NAM tend to have better results when it comes time for surgical repair. By the end of treatment, the mouthpiece is removed and the nose is aligned to be more symmetrical. The gradual process of bringing the lip and 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 September 2015