The Cleft Palate and Craniofacial Institute at St. Louis Children’s Hospital is one of few centers in the Midwest with expertise in nasoalveolar molding (NAM) to correct cleft lip and palate.
The NAM procedure uses an orthodontic device in the mouth to help shape and improve the position of the nose. This makes it easier for plastic surgeons to form a symmetric lip and nose, achieving a more natural appearance after one procedure.
Depending on the patient, the NAM procedure may eliminate the need for a secondary surgery involving lip revisions and nasal reconstruction. The technique improves results in clefts that affect one or both sides of the mouth.
The NAM procedure
NAM begins as soon as possible — as early as the baby’s first week of life. Here’s how the process works:
- A pediatric dentist makes 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. During this time, the baby visits the pediatric dentist every week in order to make adjustments to the NAM device.
- Once the cleft has shrunk to about 5 millimeters, the dentist adds a wire with an acrylic tip that fits into the nose. The acrylic tip gently lifts the nose. 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.
How long will my baby wear a NAM device?
Babies with unilateral clefts (clefts that affect only one side of the mouth) usually wear the NAM device for about three months. Babies with bilateral clefts (clefts that affect both sides of the mouth) may need the device for up to six months.
Your baby will be scheduled for surgery once the plastic surgeon and dentist agree that the best results possible have been achieved.
Is my baby a candidate for the NAM procedure?
To be eligible for NAM, a baby must have a parent or caregiver able to:
- Clean the device and tape it in place on a regular basis
- Deal with skin or mouth irritations
- Make weekly trips to the dentist at St. Louis Children’s Hospital
Is passive molding a good alternative to NAM?
Passive molding is an alternative to NAM that achieves results equal to NAM with fewer follow-up appointments.
Compared to the NAM device, the passive molding device:
- Can be inserted slightly later (within about six rather than three weeks of birth)
- Requires follow-up appointments only once every four to six weeks, rather than once a week
Passive molding is a great option for families unable to make weekly trips to the dentist due to distance. The dentistry team at St. Louis Children’s Hospital — who pioneered passive molding — have found that it achieves results comparable to NAM for many patients.
