Overview

What Is Naso-Alveolar Molding?

What Is Naso-Alveolar Molding?

Most children with cleft lip will need naso-alveolar molding (or NAM). NAM is an orthopedic device babies wear before having surgery. NAM helps bring your child's gum line together where their teeth will eventually form.

Babies use NAM early in infancy to narrow their cleft lip. Using a NAM device also increases the chance cleft lip surgery will be successful. 

A NAM device also reshapes your child's nostril so it is rounder. This improves how your child's nose will look after their lip is repaired.

When Should My Child Use NAM?

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Presurgical devices like NAM have the best chance of working when babies begin using them during the first few weeks of life. We often make special arrangements to help design a presurgical plan. A presurgical plan will help your child have the best lip and nose later in their life.

Even if your child’s cleft is not wide, your child may need their nose or nostril reshaped so their nose will look more normal.

What if My Family Lives Far Away From Salt Lake City?

Our pediatric facial plastic surgeons treat many children who live far away from Salt Lake City. But some families who live long distances from Salt Lake City may have extreme difficulty traveling to the hospital for regular adjustments. 

Some of these families may choose a lip adhesion or a taping system instead of NAM. These alternatives also prepare your child for cleft lip surgery.

We can help your family make these difficult decisions. For example, if your child needs a lip adhesion and we decide it would be best to combine treatments, we may repair your child’s cleft lip and cleft palate during the same surgery.

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NAM Alternatives: Lip Adhesion

NAM devices help most cleft babies. But a child must wear a NAM device for a long time. Having a NAM can also be hard on your family if you live far from away from the hospital.

Because of these reasons, some families may choose a lip adhesion procedure instead. Lip adhesion procedures help shape and mold a child's face. 

How Does Lip Adhesion Surgery Work?

In lip adhesion procedures, surgeons bring together the lip on the side of your child's cleft without harming the tissue they will later use to repair your child’s cleft lip. Protecting this tissue allows your child's lip to provide tension on their face, which slowly improves how your child's face looks. 

Surgeons often choose lip adhesion for children with wider clefts. However, the tissue around your child’s lip may become damaged because tension from face muscles pull at the lip.

Your surgeon can meet with your family to discuss NAM alternatives and help you choose the best treatment for your family's needs. 

Feeding & Weight Gain

During one of your first visits, your surgeon will talk about feeding challenges. Most children with a cleft grow and develop normally and healthfully.

But some infants with a cleft need more help and attention to get the nutrition they need to grow and heal from their upcoming surgeries. 

Your surgeon and other infant feeding experts will evaluate your child to make sure your infant doesn't have airway, breathing, or swallowing problems. These problems can interfere with feeding. For example, breathing problems can cause some children to choke and aspirate during feeding. During aspiration, milk can go into your baby's lungs.

Many providers do not know about the challenges of feeding cleft babies. Some doctors may not know how to evaluate your child or address your concerns. Our pediatric facial plastic surgeons work with children with breathing problems on a daily basis.

Interdisciplinary Care

Our surgeons are experts in cleft care. We often coordinate teams of doctors to help the most complex children—including many without cleft lip and palate. 

We will evaluate your child's breathing and airway. We also work with speech and language pathologists to treat breathing and swallowing problems in infants and older children.

We often work closely with the cleft team's prosthodontist. A prosthodontist is a specialist who makes and adjusts the NAM device. Working with a prosthodontist helps us improve your child’s lip and upper jaw.

For children who have more complex lip and face problems, we work with the prosthodontist to tailor the NAM to your child's needs. This improves chances that the NAM device will work successfully.

Common Questions

What if I can't return to the doctor's office every week for NAM adjustments?

If it is too hard for your family to return to the hospital each week, your surgeon can discuss the alternatives and help decide on the plan that is right for you and your child.

Does the NAM device hurt?

NAM devices today usually do not hurt when surgeons place them or when your child wears them. Like anything new, your child may behave differently while they are getting used to the NAM. 

In rare cases, the NAM device can cause a sore on the upper jaw or palate. If this happens, we will work with your child’s prosthodontist to find a solution.

Some of the first presurgical devices were pinned to the upper jaw. Surgeons needed anesthesia to place these devices. But doctors discovered that these devices harmed growth in the upper jaw and face, so they are no longer commonly used. 

Does every baby with a cleft need a NAM device?

The NAM device can be very helpful for children with wide clefts. NAM can bring the edges of the cleft closer together. It can also help children with a flattened nose (called a cleft nasal deformity).

Some babies with a cleft lip do not have these problems. These babies will not need NAM.

Most babies with a cleft lip and an asymmetric (or unstraight) nose have the best outcome with the nasal part of the NAM device. For some children, we only need to shape the nose or nostril. Your surgeon will help make this decision.

Some babies have medical problems or trouble breathing. In these cases, we closely monitor breathing when babies wear the NAM. Occasionally we decide not to use a NAM at all. But this is uncommon and your surgeon can help work through any issues that arise.

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