Nasoalveolar molding (NAM) is a presurgical orthopedic technique developed to treat infants born with cleft lip and palate. The process closes the alveolar and lip segments, rounds out the dental arch and helps shapes the nostril on the cleft side. Achieving these goals before the first surgery enables the craniofacial surgeon to achieve a better result and allows for better growth long-term.
How is NAM different from other types of presurgical orthopedics?
The greatest benefit of NAM is the improvement in nasal shape. Correction of the nose in infants with cleft lip and palate remains one of the greatest challenges for surgeons. Through the use of NAM, presurgical alignment in the unilateral cleft improves nasal symmetry. In the bilateral cleft, NAM decreases the width of the nose and is specially designed to lengthen the columella and increase tip projection.
How does NAM work?
A mold of the infantís palate is taken soon after birth. A customized plate is made and held in place by surgical tapes to the cheeks. An extension, or stent, extends from the tray and inserts into the nostril(s). The plate is worn by the baby all of the time, including during feedings. Every week, the tray is modified to mold the tissues into the desired shape and position. The primary surgery is performed at three to four months of age.
Why does NAM work?
As a result of the effect of maternal estrogen, the cartilage in an infant is plastic (moldable) for three to four months after birth. As the infant ages, the cartilage becomes elastic and can no longer be molded. It is essential to start NAM as soon after birth as possible to achieve optimal results in nasal shape.
Who performs NAM?
Nasoalveolar molding is performed by the teamís craniofacial orthodontist, Dr.Deirdre Maull. Dr. Maull completed a fellowship at the Institute of Reconstructive Plastic Surgery, NYU Medical Center, where the technique was developed.
NAM and Patient Outcomes:
Nasoalveolar molding optimizes functional and aesthetic outcomes of the cleft lip, alveolus, and nasal complex.
Reduces need for secondary surgeries or revisions, making presurgical intervention cost-effective (significant cost savings).
Reduces scar width by helping to close the lip and alveolar processes without the tension that is present using a traditional approach to lip repair.
The NAM addresses the nasal asymmetry that is present in infants with cleft lip and palate.
May aids with infant feeding because it acts as an artificial palate closing up the opening into the nasal area.