Nasoalveolar Molding (NAM)
Nasoalveolar (pronounced nay-zoh-al-VEE-uh-ler) molding (NAM) is a nonsurgical way to reshape the gums, lip, and nostrils with a plastic plate before cleft lip and palate surgery. Pre-surgery molding may decrease the number of surgeries your child needs because it makes the cleft less severe. NAM also improves the shape and position of the lip and nose. With a smaller cleft, there is less tension when the surgeon closes the cleft. Molding the lip and nose in advance can mean less reshaping is needed during surgery.
NAM is used mainly for children with large or wide clefts and has greatly changed cleft repair. It reduces the cleft inside the mouth, reduces the gap in the upper lip, and lifts and narrows the nose. Surgery is done after the molding is complete.
How does NAM work?
NAM works by gently directing the growth of your baby’s gums and the shape of their nose during the first few months after birth, when these tissues are soft and easy to mold.
Your baby wears a custom molding plate 24 hours a day, 7 days a week, including when they are feeding. The plate is held in place using small rubber bands that are taped to your baby’s cheeks. You change the rubber bands and the tape and clean the molding plate at home as needed (usually each day). Dr. Ryan will teach you how, so it’s easy for you to do at home.
Every 1 to 2 weeks, Dr. Ryan makes small changes to the shape of the molding plate to guide the baby’s gums as they grow.
Once the gap in the gums is small enough, Dr. Ryan adds a post(s) covered with smooth, rounded plastic to the front of the molding plate. This post (called a nasal stent) slides easily into the baby’s nostril(s). It slowly lifts the nose and shapes the nostril on the side(s) of the cleft.
How does NAM feel for my baby?
The molding plate and nasal stent(s) are not painful. Unlike some older techniques, NAM does not push or stretch the delicate tissues; it only helps gently direct their growth (called passive molding).
After getting used to the plate for a few days, many babies seem happier wearing it than they did without it. This may happen because the plate acts as a palate (roof of the mouth), so it keeps your baby’s tongue from pushing into the cleft, and it makes feeding easier for your baby.
What type of surgery is done after NAM?
After molding is complete, your child will have surgery to pull their lip together and to further shape their nose. We partner with Carolina Center for Cleft and Craniofacial Surgery ( https://mycenters.com/cleft-center/cleft-craniofacial-surgery/ ) who use surgical techniques designed to decrease the size of the incisions and the number of surgeries your child needs to get the best results (better shape of the lip and nose). With a better result from the first surgery, your child may need fewer surgeries later in childhood.