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NAM Appliances for Cleft Palate

Treatment of Cleft Palate at Dental Health Orthodontics in Madison

About Us

Dr. David Allen and his orthodontic team have been fabricating Nasoalveolar Molding (NAM) appliances since 2012 with amazing results. Together with plastic surgeons Dr. Delora Mount & Dr. Catharine Garland at UW Children’s Hospital, and Dr. Matthew Pogodzinski at SSM Health 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 honored to be the only Madison area NAM treatment clinic, and one of only two orthodontic offices in the entire state of Wisconsin to provide this therapy to babies in need of a NAM appliance.

cleft lip
Lisa Virnig, Angela Chandler, Dr. David Allen

Meet the Team

Dr. David Allen – Dr. Allen is an orthodontic specialist at our West & South Orthodontics Clinics. He serves as the orthodontist for the UW Hospital Cleft Palate Craniofacial Team. He has a special concentration in orthodontics for cleft lip and palate patients. Improving the smiles of children is his favorite part about orthodontics and he is especially passionate about building relationships with his patients and their families. He wants parents to know that the NAM appliance may seem overwhelming, but treatment is only a short period of time to provide their child with a lifetime of smiles, and he is always available to help them throughout the process.

Angela Chandler – Angela is a Nationally Certified Dental Laboratory Technician and has been a dental technician since 1994. She joined the Dental Health Orthodontics team in 2012 and works at the West and South Orthodontics Clinics. Her role in the NAM process is to make the appliance and also makes all future adjustments during follow-up appointments. Angela is passionate about her role and she treats each baby as if it was her own. She says, “I want the best care for them and the best results. Every baby is different and each one has different needs. I want parents to know that they can contact me at anytime, whether it is day or night and want them to know that I am here for them. Getting to know each individual baby is so wonderfully rewarding and I love it. I love to see the changes in the treatment as the weeks go by and I love building lifelong relationships with all of our patients and their families.”

Lisa Virnig – Lisa is an Orthodontic Assistant and started her career at DHA in 2008. She has been part of the NAM Team since 2014 and works at the West Orthodontics Clinic. Her role is to meet with parents to go over NAM instructions, provide supplies, take photos, answer questions, and partner with Angela & Dr. Allen throughout the process. She wants parents to know that, “The NAM process can be very daunting and the first visit can feel overwhelming, but once parents become familiar with the NAM device, they will see how they can easily incorporate it into their daily life. I love working with parents and babies and it is always rewarding to see how much the babies change and grow throughout the process. My favorite part of my job is being able to show parents a comparison of the first week before the NAM to the final week of treatment!”

Nasoalveolar Molding Devices

What is a NAM device?

It is a clear acrylic appliance that  is customized to comfortably fit into the roof of the baby’s mouth. It is an orthodontic retainer that helps align the palate and give a better shape to the nose. 

Taking the Appliance Impression

The impression is taken at the surgeons office. It takes just a few minutes. We do have the parents leave the room.  Some babies may cry however nothing we do hurts your baby and most babies sleep through the impression taking.

What to Expect During the First Fitting?

The first fitting appointment will be slightly longer than follow-up visits because we will be placing the NAM appliance in a custom position for your baby and will be providing you instructions for maintenance.

What Should I Expect at Follow-up Appointments?

Some appts will be longer than others and appointment length will be based on the individual needs of the infant. 

Adjustment appointments will be shorter in duration. During these appointments we will be modifying the appliance to ensure that the lips are pulled together. 

Nasal stent appointments will be slightly longer than adjustment appointments. During these appointments we will be adding a nasal stent to provide support for the nose and help mold it into more of a natural shape.

Will I Be in the Room During the Appointment(s)?

Parents/Guardians will be in the room with their baby at all times. During the visit the baby may cry, but the adjustments will not cause them pain. Babies in general do not like to have people touching their mouth area and we will often swaddle them to make them more comfortable.

How Long Does The NAM Process Take?

The process will vary based on each infant. Treatment varies anywhere from 3-6 months.

Unilateral Cleft Lip

Unilateral NAM Device

Bilateral Cleft Lip

Bilateral NAM Device

Before & After Photos

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NAM FAQs

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 gap in the infant’s mouth, and the nose area may be pushed off center. In a bilateral cleft, the upper jaw bone may protrude from the mouth, and the nose appears wide and flat.

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 decrease the severity of the cleft and improve the shape of the nose. When the baby is around three to six months old the molding is complete and the cleft lip is ready to be surgically repaired.

NAM treatments have significantly decreased the duration of cleft palate repair. In the past, repairing a cleft required multiple surgeries between birth and 18 years old. With NAM, the orthodontist can reduce the size of a cleft in the process leading up to 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, has trained with NAM founders Dr. Grayson and Dr. Cutting in New York. Dr. Allen and his NAM team have helped dozens of children with cleft lip and palate. 

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, but in some cases the babies have started treatment up to 3 months old. 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 have faster feedings. Since the babies get the NAM appliance at such a young age, they are able to get accustomed and adapt to it very quickly.

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 may cause slight discomfort for a couple of days.

After a few weeks of shaping the inside of the mouth, a nasal stent is attached to the NAM and extends upward into the nostril. The stent will begin the process of reshaping the nostril from a flat to a more rounded shape.

Once the cleft has been reshaped, the child will be ready for surgery. At that time the lip segments have been pulled closer together, the nose has rounded and lifted upward and forward. All these improvements lead to an easier surgical repair, a better aesthetic result, and the potential to avoid additional surgeries in the future. Weekly support and checkups with your NAM team to help you and your baby throughout the process.

  • Helps the feeding process by decreasing the air flow, which in return will make feedings quicker, and increase weight gain.
  • As the child ages and the cleft closes, it will aid in verbal skills and pronunciation.
  • Requires easier, less and faster surgeries.

DHA Orthodontics Clinic

West Gammon Clinic | Madison, WI

7001 Old Sauk Rd.
Madison, WI 53717

Phone: 608-833-2578

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