Nasoalveolar Molding Program

Nasoalveolar molding (NAM) is a pre-surgical treatment used to improve the final results of surgical repair for cleft lip and cleft palate. Surgical repair alone cannot correct the multiple problems encountered with the deformities that result from clefts of the lip and palate.

The NAM process actually expands tissues prior to surgery. An acrylic orthopedic appliance is used by dentists to approximate the cleft and mold the nose, reducing the amount of surgical correction required during treatment (in the majority of cases, children only need one surgery as opposed to two surgeries under general anesthesia to repair cleft lip and palate).

Timing is very important. The ideal time to begin NAM is one to two weeks after birth and before six weeks of age. At birth there is a high level of hyaluronic acid in the infant, which begins to fall off after six weeks of age. The presence of hyaluronic acid in the body makes molding the tissue and bone more easy.

How Nasoalveolar Molding Helps

Cleft lip and palate often leave the middle part of the nose and the nasal cartilage deformed. Surgery alone is often not enough to provide an aesthetically acceptable correction. The NAM technique takes advantage of the malleability of immature cartilage of the nose and the ability to non-surgically construct the columella (middle part of the nose) through the application of tissue expansion. By the addition of a nasal portion to the molding plate, we can often correct the nasal tip, the base on the affected side and the position of the philtrum and columella.

NAM Treatment Goals

• To restore the correct skeletal, cartilaginous and soft tissue relationship pre-surgically
• To align and approximate the intraoral alveolar segments (greater/lesser segments)
• To correct the malposition of the nasal cartilages
• To correct the nasal tip and the alar base on the affected side(s), as well as the position of the philtrum and columella

Team Members

The nasoalveolar molding team provides care in concert with the hospital's cleft palate team. This group consists of surgeons, pediatric dentists, orthodontists, prosthodontists, psychologists, therapists, translators, geneticists, case managers and make-up artists (for some of our older patients).

Support for Care

The children served by this team have all made a wonderful recovery. Many of the services provided by the team are considered to be "non-essential" by insurance providers and other organizations. Consequently, in order to continue to provide these very valuable services to the children, we must look for generous donors for the funds needed to support this important project.

Our team currently provides care for approximately twenty infants each year at our hospital. We hope you will consider supporting our efforts by contributing to the costs to treat these infants.

Resources

NAM appliance home care for the bilateral cleft lip and cleft palate patient (video):