Nasoalveolar molding (NAM) is a non-surgical treatment for infants born with cleft lip and palate. This method uses a custom-made plastic plate to gently reshape the baby’s gums, upper lip, and nostrils. It is a preparatory treatment, initiated within the first few weeks of an infant’s life, to improve anatomy before surgical repair.
The Purpose of Nasoalveolar Molding
The primary goal of nasoalveolar molding is to reduce the size of the cleft in the gum line, also known as the alveolus, and to improve the alignment of these segments. This process helps bring the separated lip segments closer, creating a better foundation for subsequent surgical repair.
NAM therapy also aims to improve the symmetry and shape of the infant’s nose. For infants with a cleft, the nasal cartilage on the affected side can be displaced, leading to an altered nostril shape and a wider nostril base. By gently guiding the tissues, NAM helps lift and narrow the nose, improving its overall form and position. These pre-surgical changes contribute to better long-term aesthetic and functional outcomes, potentially reducing the need for multiple surgeries.
The Treatment Process and Timeline
NAM treatment begins within the first few weeks after birth, ideally when the infant is 1 to 2 weeks old, as facial tissues are still soft and pliable due to hyaluronic acid. The initial step involves an orthodontist taking a gentle impression of the infant’s upper jaw using medical-grade silicone. This impression is then used to create a custom acrylic molding plate, which resembles a dental retainer.
The infant wears this custom molding plate continuously, even during feedings. The plate is secured in the mouth with small rubber bands taped to the baby’s cheeks. Regular adjustments are made by the orthodontist during weekly or bi-weekly visits to gradually guide the growth of the gums and narrow the cleft. These appointments involve the orthodontist making small modifications to the plate.
Once the gap in the gums has significantly reduced, a nasal stent is added to the molding plate. This stent fits into the nostril to gently lift and shape the nasal cartilage on the side of the cleft. The stent is also adjusted incrementally during subsequent weekly visits. The entire NAM treatment lasts for 3 to 6 months, concluding just before the primary lip repair surgery, which often occurs around 6 months of age.
Caring for an Infant with a NAM Device
Parents and caregivers are instructed to remove the device once daily for cleaning. The molding plate should be cleaned with warm water and a mild dish soap to prevent debris buildup and potential fungal infections. Before re-inserting, the device should be inspected for any rough spots or changes that could irritate the infant’s mouth.
The device is then re-inserted into the infant’s mouth, secured with adhesives or tape for continuous wear. While infants may initially be unsettled, they adapt quickly, as the plate can improve feeding by providing a solid surface for the bottle nipple and preventing the tongue from pushing into the cleft. Parents are also advised to monitor for any signs of skin irritation, sores, or ulcers and to consult their medical team for concerns.