NAM Appliances for Cleft 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 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.