Nasoalveolar molding (NAM) is a nonsurgical technique that has revolutionized the treatment of children with large clefts of the lip and palate. In the past, a large cleft required multiple surgeries during a child’s growth years (birth to 18), which put the child at risk for psychological and social adjustment problems.
Now, within a few weeks of birth, babies can be fitted with a painless, custom-made molding plate that looks like a dental retainer and that gently directs the growth of gums, lip and nostrils. This is possible due to the high levels of maternal estrogen present for several months after birth. Special elastic tape may be used on the lips with or without the appliance.
Because the plate causes no pain, babies adjust to its presence in a few days and can wear it 24 hours a day, seven days a week, even while feeding. The orthodontist adjusts the molding plate every week or two, depending on the progress.
By lessening the severity of the cleft lip or palate before surgery, NAM helps surgeons get a better result from the first surgery, which means fewer surgeries later in childhood.
For most infants with cleft lip alone, the abnormality can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). This will be decided by your child’s surgeon. The timing of lip repair for infants undergoing NAM treatment will be determined by the orthodontist and the surgeon based on the position of the gums and nose. It is usually done at 4-6 months of age. The goal of this surgery is to fix the separation of the lip. Sometimes, a second operation is needed.
Cleft palate repairs are usually done between the ages of 10 to 18 months. This is a more complicated surgery and is done when the baby is bigger and better able to tolerate the surgery. The exact timing of the surgery will be decided by your child’s physician. The goal of this surgery is to fix the roof of the mouth so that your child can eat and learn to talk normally. Sometimes, a second operation is needed.
Bone grafting the dental ridge of the upper jaw is a procedure that may be performed on patients with cleft lips and palates. By taking small amounts of bone from elsewhere on the body, such as the hip, surgeons can reconstruct the area of the cleft near the teeth. The bone graft allows for the formation of a continuous upper gum, supporting the teeth, lip, and nose, and improving facial symmetry and stability. This procedure is often performed before the age of 10. Once the bone graft is in place, missing teeth can be replaced by moving adjacent teeth, using a dental bridge, or implanting dental metallic bone