For many newborns with a cleft lip or palate, reconstructive treatment can begin soon after birth with use of a pre-surgical device known as a nasoalveolar molding (NAM) appliance. This appliance, which is made of acrylic, is used by the Craniofacial Center team to support repair of a child’s lip and nose, and can help reduce the amount of surgical treatment required. The device is utilized to:
Restore the relationship between the skeleton, cartilage and soft tissue pre-surgically
Align and approximate the alveolar segments
Correct positioning of the nasal cartilage
Correct the nasal tip, the position of the area below the nose extending to the upper lip, and the portion of the nose between the nostrils
Children should be evaluated by the Craniofacial Center staff shortly after birth, preferably when the infant is 1 to 2 weeks old. At that time, the team will assess the child to see if he or she is a candidate for the NAM device.
Treatment Stages and Duration
Once a child is identified as a candidate, treatment is coordinated in stages.
Stage 1 (Leveling and alignment of alveolar segments):
- First, an impression will be taken of the child’s palate using a soft, putty-like material inside an impression
tray. A nasal impression may also be made.
- When the device is initially inserted, you and your baby will be asked to remain at the doctor’s office for a couple of hours for monitoring.
- Thereafter, the plate will be adjusted approximately every two weeks. The alveolar segments will be moved about two to three millimeters with each adjustment.
- The device will be kept in place with a special tape and elastic bands that will apply upward and backward pressure.
Stage 2 (Addition of nasal stent):
At this stage, a nose piece will be added to the mold to support the nasal tip and promote the growth of tissue. The
nose piece will be modified at each visit, according to the child’s individual needs. After receiving the nose piece, the child will produce more saliva initially until he or she adapts to the appliance. Adaptation takes approximately two days.
The length of time that treatment is maintained depends on each patient and his or her specific needs. The device is typically utilized until surgery is performed.
The following are before, during and after surgery pictures:
Care of the NAM Device
The NAM device is most effective when kept in place at all times. It should be removed only twice a day for cleaning.
- Clean the NAM with a small brush and cold water. Also, clean the infant’s mouth well when the NAM is
removed for cleaning, and check the mouth for any pressure irritation. You can clean the child’s mouth with a clean cloth and water.
- The adhesive tapes should be changed every three days. You will be provided with an initial supply when you receive the NAM. Additional supplies can be purchased from a medical supply store.
Questions or Issues
If during the course of treatment you have questions or concerns, please call the Nicklaus Children's Hospital, formerly Miami Children's Hospital, Craniofacial Center at 305-662-8237.