Plastic and Craniofacial Surgery
Babies with cleft lip and palate are born with a separation of the lip, gums and palate. The separation of these structures also causes a deformity of the nose because the nostril straddles each side of the cleft.
In most cases, several staged surgeries are required to restore normal function and appearance to the affected structures. Nasoalveolar molding (NAM) therapy was introduced to improve the results of cleft lip repair.
NAM is started shortly after birth to guide the growth of the facial bones to narrow the gap in the gums. As the width of the gap is reduced, the shape of the lip and nose can be improved prior to surgery. We believe that NAM allows us to achieve better functional and aesthetic results and may lead to needing less surgery in future.
NAM uses a custom-made molding plate that we call a NAM appliance. The appliance fits the gums like a denture and works by guiding the growth of the ends of the gums toward one another. This narrows the width of the cleft.
Once the gums grow closer to one another, the skin and cartilage of the nose can be molded into a better position and shape with an extension from the NAM appliance.
Babies born with cleft lip and palate visit the Children’s Health℠ cleft orthodontist within two weeks of their birth. At their initial visit, the pediatric orthodontist will take an impression of the gums that is used to make the NAM appliance. The appliance is given to the family about one week from the time of the impression.
The NAM appliance is held into position in the baby’s mouth by applying a small amount of denture adhesive to the device and tape applied to the cheeks. The baby wears the appliance almost 24 hours a day, including during feeding. The appliance is only removed when it needs to be cleaned, which is every 12 hours. The tape is replaced as needed. At the visit when the NAM appliance is given to the family, the orthodontic staff helps the family practice putting in the appliance. We make sure the family feels comfortable with the process before going home. All of the supplies needed are provided to the family with the delivery of the appliance.
The NAM appliance can affect the way your baby feeds. Our feeding specialists routinely re-evaluate your baby’s feeding after the NAM appliance is in place. Usually, feeding efficiency is improved with the NAM appliance in place.
After you receive the NAM appliance, the orthodontist will adjust it every week at the beginning of treatment. This interval may change depending on treatment progress. During these adjustments, space is created at the ends to allow room for the gums in the appliance. The gums will then grow into this space over the next week. Each appointment typically lasts between 30 minutes to an hour. Typically, the gap in the gums (alveolar segments) will be approximated first. Once this is achieved, the tension is taken off the nostril, allowing shaping of the nose (nasal cartilage). A nasal prong is added to the NAM appliance during the nasal shaping part of the treatment.
We continue NAM until the desired corrections in the gums, lip and nose are achieved. The average duration of treatment is between three to four months, but this may vary according to individual needs.
NAM is an effective technique that is applied by parents daily. We find that parents receive a huge sense of satisfaction by playing an active role in helping improve their child’s results from cleft surgery by taking part in the NAM process.