What is Nasoalveolar Molding?

Nasoalveolar molding (NAM) is a non-surgical treatment for shaping the gums, lip and nostrils before cleft lip and palate surgery.  The goal of NAM is to reduce the severity of the cleft before surgical repair by the plastic surgeon.  Surgery is performed after the molding is finished, approximately three to six months after birth.

NAM is used mainly for children with large clefts or deformity of the nostrils.  In the past, fixing a large cleft required multiple surgeries.  The first procedure pulled the lip together, a second improved the position of the lip, another two would be for the nose, then another would close the palate, and so on.  NAM allows the orthodontist and surgeon to improve a large cleft in the months before surgery.  A smaller cleft can help the surgeon obtain improved shape of the nose and a thinner scar in only one surgery.  A better result in the first surgery, means fewer surgeries later in childhood.

How does NAM work?

NAM is accomplished with an orthodontist.  Your child will be fitted with a custom-made molding plate that looks like an orthodontic retainer.  The device is attached with small orthodontic rubber bands that are taped to the baby’s face.

The molding plate causes no pain and after the first few days the plate usually doesn’t bother babies at all; it’s an accepted part of their face.  The molding plate helps gently direct the growth of the gums.  The baby wears the molding plate 24 hours per day, seven days a week, including during feeding.  Parents change the tape and clean the molding plate daily as needed.

The orthodontist gently adjusts the shape of the molding plate every one to two weeks, sculpting the plastic.  Each adjustment is very small, but it starts to guide the baby’s gums and nose as they are growing. Each appointment takes about 60 minutes.  After the cleft is small enough, a post is attached to the molding plate and placed in the nostril.  This post is then gently adjusted to lift up the nose and open the nostril.

By the time of surgery, the nose has been lifted and narrowed, the gap in the gums is smaller, and the lips are closer together.  A smaller gap means less tension when the surgeon closes the cleft.

Nasoalveolar Molding Handout (NAM)