Children's Hospital Colorado

Nasoalveolar Molding for Infants with Cleft Lip and Palate

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What is nasoalveolar molding (NAM)?

Nasoalveolar molding (NAM) is a pre-surgical orthodontic procedure to help babies born with cleft lip and palate. It’s done to help make the clefts of the gum pads, lip and palate smaller, so later surgery is easier and more predictable. NAM also helps to reshape the nose to be more symmetrical before repair and reduce the number of surgeries later. Children’s Hospital Colorado is one of the few hospitals in the country that offers this procedure.

The NAM procedure starts shortly after birth. We place tape across your baby’s lip to start bringing the lip and gums together. Taping also helps keep the cleft small and prevents your baby’s tongue or bottle from making it bigger. Even if we decide not to pursue NAM for your child, lip taping can help improve the severity of the cleft and shape of the nose.

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The next step in the process is the NAM appliance. Your baby will wear a custom-made NAM appliance in their mouth to help close the cleft as they grow. The NAM appliance is made by a trained dentist or orthodontist to fit the roof of your baby’s mouth. It looks like a small denture or a mouth retainer that fits over the roof of the mouth.

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When the size of the cleft between the gum pads has narrowed, your baby’s provider adds an extension to the appliance called a nasal stent. This extension molds and shapes your baby’s nose without surgery.

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H2: How is the NAM appliance made?

The dentist or craniofacial orthodontist takes an impression of your child’s upper jaw. The specialist holds the impression tray in place in your baby’s mouth until the molding material is set. Your baby may cry when the impression is made, but it doesn’t hurt. Once the tray is taken out, we check your baby’s mouth to make sure there is no material left. The dentist or craniofacial orthodontist then uses the impression to make the appliance.

What is the NAM process?

Your child will wear the appliance for 3 to 6 months. It is held in place by tape on the cheeks. The tape also helps to move the gum pads and lips closer together. You’ll need to remove the appliance to clean it at least once each day. Most babies take a day or two to get used to feeding with the appliance.

Your baby will need to see their doctor every 1 to 2 weeks to have the appliance adjusted.

Once the clefts have closed and the nose is molded, your baby will have their first surgery to repair the lip and nose.

In addition to closing a cleft, the NAM appliance has other benefits:

  • Helps reduce sores that often develop in the mouths of babies with cleft lip and palate
  • Reduces the amount of milk that goes into the nose through the open palate
  • Often makes feeding easier

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