NAM Appliances for Cleft Palate
Dental Health Associates is the Only Madison Area Clinic to Offer NAM Therapy for Patients with Cleft Palates
Dr. David Allen and his orthodontic team have been fabricating Nasoalveolar Molding (NAM) appliances since 2012 with amazing results. Together with the plastic surgeons at UW Children’s Hospital and Dr. Delora Mount, many babies have been successfully treated with a NAM appliance. We are proud of and impressed by the results the NAM has produced for patients, and are excited to provide this service for patients of Dental Health Associates. We are also excited to be only one of two orthodontic offices in the entire state of Wisconsin to provide this therapy to babies in need of a NAM appliance.
NAM Before and After Photos
In Progress NAM Photos
What is Cleft Lip and Palate?
Cleft lip and palate is among the most common birth defects in the United States, occurring in about one out of every 1,000 newborns. It is diagnosed when there is an actual split in the tissue of the baby's upper lip and in the roof of the mouth. The deformity can occur on one side of the mouth (unilateral) or both sides of the mouth (bilateral). A unilateral cleft creates a large hole in the infant’s face, and the nose may be pushed off center. In a bilateral cleft, the upper jaw bone may overly protrude from the mouth, and the nose appears wide and flat.
What is Nasoalveolar Molding?
Nasoalveolar Molding (NAM) is a nonsurgical method of reshaping the gums, lip and nose before cleft lip and palate surgery. The NAM appliance is a small removable device similar to an orthodontic retainer. It gradually applies pressure to lessen the severity of the cleft and improve the shape of the nose. The cleft lip is surgically repaired once the molding is completed, usually at about three to six months after birth.
NAM has revolutionized cleft repair. In the past, repairing a cleft required multiple surgeries between birth and age 18, putting the child at risk for psychological and social adjustment problems. With NAM, the orthodontist can reduce the size of a cleft in the months before surgery. This helps the surgeon get a better shape of the nose and a thinner scar in only one surgery. Often times the NAM can prevent future surgeries that were once required later in childhood, such as alveolar bone grafting.
NAM was developed in the 1990’s at New York University Medical Center by an orthodontist, Dr. Barry Grayson, and a plastic surgeon, Dr. Court Cutting. Although many devices that are similar to the NAM have been tried for decades, the NAM has had the greatest success and has been established as safe and effective. Our DHA orthodontist, Dr. David Allen, and his orthodontic assistant have both trained with NAM founders Dr. Grayson and Dr. Cutting in New York.
What is the process?
To begin NAM, a dental impression is made of the newborns upper jaw at about one week of age. A plastic molding appliance is then made and fitted between 1-2 weeks of age. The NAM appliance is held in the mouth with small rubber bands that are taped to the babies cheeks. The babies wear the NAM 24 hours a day, seven days a week. It is even worn during feeding. The NAM acts as an artificial palate allowing the babies to get better suction on the bottle which in turn enables them to gain weight. Since the babies get the NAM at such a young age they become use to it very fast and it becomes an accepted part of their face.
Adjustments are made to the NAM appliance on a weekly basis by reshaping the plastic to gently apply pressure to mold and redirect the growth of the upper jaw and lips. Each adjustment is very small and causes no pain to the baby.
Once the cleft in the gums has been reduced to about a quarter of an inch a nasal stent is placed. The nasal stent is attached to the NAM and extends upward into the nostril to start reshaping it from a flat to a more rounded shape.
By the time the child is ready for surgery the size of the cleft has been reduced, the lip segments have been pulled closer together and the nose has been rounded and lifted upward and forward. All theses improvements lead to an easier surgical repair, a better esthetic results and the potentially avoid more future surgeries.
What are the benefits to NAM ?
- Helps the feeding process once the baby is used to the appliance
- Baby will gain much needed weight once it starts feeding naturally
- Weekly support and checkups help you and your baby
- As the child ages and the cleft closes, speech will be much easier to learn
- Increased self confidence once the child moves forward to adulthood
What are the results like?
The NAM is such a simple concept in design and function, but the results speak for themselves. The scarring is minimal and the nostrils are more round after surgery. A better result in the first surgery means fewer surgeries later in childhood. In select cases, a certain surgery (GPP) can be performed to completely close the cleft in the gums at the time of the surgery. Doing a GPP at this time can prevent the need for a future alveolar bone graft in approximately half of the babies. Please consult your doctor about whether your not your infant is a good candidate for a GPP.
Download the NAM Instructions 2