Cleft lip and cleft palate are among the most common birth defects.
- A cleft lip (Picture 1) is the result of the lip not fusing (joining) together. This happens during the first few months of a baby’s development in the womb. It often includes the separation of the upper gum line.
- A cleft palate is a separation in the roof of the mouth. This is caused by the sides of the palate not completely fusing together (Picture 2).
A nasoalveolar mold(called NAM for short) treats both cleft lip and cleft palate. It is an appliance that is put into the top of a baby’s mouth. The NAM slowly moves the gums closer together and helps to close the gap where the cleft is. “Naso” means nose, “alveolar” is where the gum line is and “molding” means to shape. Nasal stents (small acrylic pads) are used to form the nose cartilage to a more normal shape.
If your baby has a bilateral (two-sided) cleft, the nasal stents will be combined with taping. This will help lengthen the skin column between the two nostrils (called the columella).
Using the NAM and reshaping the gums and nose should help your baby look better. It will also lessen the number of operations he or she will need.
How the NAM Works
Unlike some older techniques, the molding plate does not push or stretch your baby’s delicate tissues. The NAM only helps gently direct the growth of the gums.
The plate will fit up on the roof of your baby’s mouth. The molding plate is attached with small orthodontic rubber bands that are taped to your baby’s face.
Every week the orthodontist slowly adjusts the shape by sculpting the plastic. Each adjustment is very small, but it starts to guide the baby’s gums as they are growing.
Once the cleft gap in the gums is small enough (around a quarter inch) a post is attached to the molding plate and inserted in the nostril. This post is then slowly adjusted every week to lift the nose and open the nostril.
When To Begin NAM Treatment
Timing is very important. The best time to begin NAM is 1 to 2 weeks after birth. At birth there is a high level of hyaluronic acid in an infant’s body. This helps make the cartilage in the nose and gum easier to shape. The level of hyaluronic acid begins to fall off after 6 weeks of age. Your baby will be less likely to be able to remove the appliance from his or her mouth if this is done at a very young age.
Prenatal Counseling: Sometimes a mother will be made aware of her baby’s cleft lip or palate before her baby is born. The cleft lip and palate team at Nationwide Children's Hospital can schedule an appointment for you to meet the team and ask any questions you may have.
Postnatal Consultation: Once your baby is born you may have questions about whether or not your baby is a good candidate for NAM treatment. Schedule an appointment with the cleft lip and palate team at Nationwide Children's Hospital. You will learn more about your baby’s own needs and the benefits of NAM treatment.
Records and Impression
If you have already decided to start NAM treatment we will schedule an appointment to assess your baby and begin keeping records. Photos will be taken and a thorough clinical exam will be done. An orthodontist will take an impression of your baby’s upper jaw with a soft medical grade silicone. This does not cause pain.
Your baby will need to stop feeding 2 to 3 hours before the impression is made. He or she may be hungry and fussy before the appointment.
Your baby might be upset when the mold is made but will calm down soon after the procedure is over.
A custom-made molding plate similar to an orthodontic retainer is delivered to you 1 to 2 weeks after the impression.
During NAM Treatment
Your baby may be upset that there is something new in his or her mouth all of the time. It is normal for babies to cry because they are not used to the new feeling in their mouths.
It may take some time for your baby to get used to the NAM and feeding might be affected for a short time.
Your baby will wear the NAM all the time (24 hours a day 7 days a week) including when eating. After the first few days your baby should get used to the appliance.
Your baby may cry when the tapes are applied or the NAM is placed into the mouth but will calm down soon after.
How to Care for the NAM Appliance
The NAM should be taken out of the baby’s mouth and cleaned with warm water, a toothbrush and dish soap once a day.
Before placing the NAM back in your baby’s mouth you should look for any rough spots that may bother your baby’s tongue or gums.
Before placing the NAM back inside your baby’s mouth you should check it for any breaks or changes. Call us right away if something is different.
Do NOT boil the NAM appliance: it will melt.
Do NOT place the NAM in the microwave.
Unilateral(one-sided) Clefts: You will need to bring your child to the clinic every week for 3 to 4 months depending on the severity of the cleft.
Bilateral (two-sided) Clefts: You will need to bring your child to the clinic every week for 5 to 6 months depending on the severity of the cleft.
You must make a commitment to weekly visits with the orthodontist. This is the onlyway to get a successful outcome from your baby’s treatment.
It is very important to us that you feel comfortable with your baby’s NAM experience. Please call the Cleft Lip and Palate Center at (614) 722-5602 if you have any questions or concerns. We will be happy to help you.
HH-I-389 10/15 Copyright 2015, Nationwide Children's Hospital
Ask your child’s health care provider for these other Helping Hand™ titles about Cleft Lip and Palate: