What is Nasoalveolar Molding?

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 surgery. Surgery is performed after the molding is complete, approximately three to six months after birth.

How is Nasoalveolar Molding (NAM) Performed?

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.

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.

The picture below shows our patient before NAM (top row of pictures). He was born with a bilateral cleft lip and palate and his premaxilla (center upper lip and bone) was obstructing his breathing through his nose. This made feeding very difficult. Through the NAM treatment, his breathing and feeding improved as can be seen in the bottom row of pictures which show better positioning of his premaxilla.

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.