Newborn babies born with a cleft lip and cleft palate can undergo Nasoalveolar Molding (NAM), a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and cleft palate surgery. This presurgical management of the infant’s cleft is intended to reduce severity of the oronasal (mouth and nose) deformity prior to cleft lip and palate surgery. Surgery is performed after the molding is complete, approximately three to six months after birth.
Nasoalveolar Molding (NAM) Procedure
NAM begins as soon as possible, and as early as the baby’s first week of life. Dr Da Silveira and her team make a mold of the newborn’s mouth. This mold is used to create the NAM device, which is similar to an orthodontic retainer.
Except for cleaning, the baby wears the device 24 hours a day. Its shape gently directs the growth of the upper jaw and gums. There are two parts of the appliance, the mouth part and the nose part with an acrylic tip that goes inside the nose. The acrylic tip gently lifts the nose; while at the same time, tape connected to the appliance pulls down on the nose. The stretching raises the flattened, cleft side of the nostril. This process gradually improves the baby’s appearance and improves the position and shape of the nose. Dr Da Silveira and her team modify the appliance weekly. Babies are seen weekly or biweekly until ready for surgery.
Frequently Asked Questions
How long will my baby wear a NAM device?
Babies with unilateral clefts usually wear the Nasoalveolar Molding (NAM) device for about three months; those with bilateral clefts may need the device for up to six months. Once the plastic surgeon and orthodontist agree the best results possible have been achieved, the baby is then scheduled for the first corrective surgery.
Is my baby a candidate for the NAM procedure?
The determining factor as to whether a baby is eligible for NAM is the parents’ commitment to dedicating the time and patience needed for the technique to succeed. Parents must clean the device, tape it in place, deal with skin or mouth irritations, and make weekly or biweekly trips to our office. For parents who are able to devote the time and effort necessary, NAM provides the best results.
NAM treatment is done differently at different centers and is not universally accepted. There are many centers that do not use NAM, either due to the lack of experience to perform the treatment or due to lack of acceptance by team members. Our team feels that NAM helps tremendously to achieve the best results in the first years of life. In the past, fixing a large cleft required multiple surgeries between birth and age 18, putting the child at risk for psychological and social adjustment problems.
The first procedure pulled the lip together, a second improved the position of the lip, another two would be for the nose, then another – often including a bone graft – would close the palate, and so on.
With nasoalveolar molding, the orthodontist and surgeon can improve a large cleft in the months before surgery. This helps the surgeon get a better shape of the nose and a thinner scar in only one surgery.
A better result in the first surgery means fewer surgeries later in childhood.
How does Nasoalveolar Molding (NAM) work?
The baby wears the molding plate 24 hours a day, seven days a week, including when they are feeding. The parents change the tape and clean the molding plate daily, as needed.
After the baby has worn the molding plate for a week, the orthodontist slowly adjusts the shape by sculpting the plastic and adding acrylic to the nose part. Each adjustment is very small, but it starts to guide the baby's gums as they are growing and to adjust the nose flatness. Each appointment takes approximately 20 to 60 minutes.
By the time of the surgery, the nose has been lifted and narrowed, the gap in the gums is smaller, and the lips are closer together. A smaller gap means less tension when the surgeon closes the cleft. In our experience, this results in a better final result than if NAM had not been done.
What is your experience with NAM?
Drs. Barry Grayson and Court Cutting at New York University Medical Center developed NAM and have established it as a safe and effective technique. Although NAM is a more recent advance in cleft care, it is an improvement of techniques that have been used in the U.S. and in Europe for decades. It is therefore not a "new fad", but is here to stay.
Dr. Da Silveira has been performing nasoalveolar molding at Craniofacial Team of Texas since 2007. Previously, she performed the same technique in Chicago from 2000 to 2007. She has done NAM in approximately more than 300 babies.
What type of NAM is done at Craniofacial Team of Texas?
We use the negative sculpturing passive molding technique with taping. Our surgical technique takes advantage of nasoalveolar molding by decreasing the size of the incisions and scars and the amount of surgery.
We will provide more information on NAM and discuss if it is appropriate for your child. Please visit our Nasoalveolar Molding (NAM) gallery page.
An orthodontist, a plastic surgeon, and a nurse practitioner specially trained in NAM are available for questions between visits.
Although your child will come to the orthodontist for adjustments to the molding plate about once a week, they will still be followed as closely as necessary by the rest of the multidisciplinary Craniofacial Team of Texas during regular clinic visits.
If you would like more information about Nasoalveolar Molding (NAM), please contact the Craniofacial Team of Texas by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.