Pre-surgical NAM Treatment for Cleft Lip and Palate
What is Nasoalveolar Molding (NAM)?
“Naso” Means nose, “alveolar” is the gum tissue that holds the baby’s developing teeth, and “molding” means to shape. Nasoalveolar molding called, NAM for short, helps to slowly move the gums closer together to close the gap where the cleft is. Nasal stents are then used to reshape the nose cartilage. If your baby has bilateral cleft, the nasal stent is combined with taping will help increase the projection of nasal tip and lengthen the columella (the skin column between the two nostrils). Using NAM and Reshaping the gums and nose will improve your baby’s appearance, and we hope that your baby will need fewer operations.
How does NAM works?
The molding plate will fit over your baby’s gums and on the roof of your baby’s mouth. The plate is held in place with orthodontic rubber bands that are taped to a baby’s face, and adhesive similar t that used for dentures. Every week the orthodontist slowly adjusts the shape by modifying the molding plate. Each adjustment is small, but it brings together the baby’s gums every week. Once the cleft gap in the gums is small enough (less than half a centimetre), a nasal stent is attached to the molding plate that inserts in the nostril (the opening of the nose). The nasal stent is slowly adjusted every week to lift up the nose, increasing the projection at the tip of the nose, and reshaping the nostril.
When should I begin NAM treatment?
Timing is very important. The ideal time to begin NAM is 1-2 weeks after birth. At birth there is a high level of hyaluronic acid in the infant that helps making the cartilage in the nose and gum easier to shape. This level of hyaluronic acid begins to fall off after 6 weeks of age. In addition, your baby will be less likely to remove the appliance from the mouth and more likely to tolerate the appliance at a very young age.
What should I expect at my first visit?
Prenatal counseling: sometimes parents will be made aware of their baby’s cleft lip and palate before their baby is born. The cleft lip and palate team can schedule an appointment for you to meet the team and ask any questions you may have.
Once your baby is born, and discharged from the hospital, contact the unit for an appointment for and appointment.
Records and scan/impression: if you and the treating health care provider have already decided to start NAM treatment, we will schedule a records and impression appointment. Photographs will be taken and thorough clinical exam will be performed. A scan or impression of your baby’s upper jaw will be made by a qualified health care provider. A custom-made molding plate, similar to an orthodontic retainer, will be fabricated based on the scan/impression and delivered to your baby 1-2 weeks after this appointment.
Will the NAM cause soreness or pain?
The molding plate and taping cause no pain, but there will be an adjustment period during which your baby will get used to something new in their mouth. This adjustment period can last a few days or 1-2 weeks, and your baby may be fussy during this time. It is essential that your baby wear the appliance 24 hours a day seven days a week, including while feeding, in order for the baby to get used to the appliance. During this adjustment period, it is important to check for signs of irritation and sore spots in the baby’s mouth and notify the doctor to adjustment the plate. After the first few days or a week, your baby should get used to the appliance, and it will be comfortable, including while feeding, and your baby will wear it at all times.
How do I place the NAM appliance?
The molding plate is held in place with tapes to baby’s cheeks and adhesive to the baby’s gum. A flexible waterproof dressing (Duoderm) is placed on baby’s cheeks to protect their sensitive skin. This can be changed every 3-5 days, removed during baths or with a gauze soaked in water, slowly and patiently once it is no longer sticking to the cheeks.
A thin layer of adhesive is placed on the plate as instructed by your doctor. Place the plate in the mouth and make sure it is flushed against the roof of the mouth with your finger and held in place for 7-10 minutes before placement of the tapes.
Medical grade tapes (Steristrip) are wrapped around orthodontic rubber bands, and the rubber band is placed on the button on the plate. Squeeze the cheeks and pull the steristrip tapes at a 45degrees angle so that the rubber bands are extended twice their size and the plate is seated on the roof of the mouth and gums. Tape the steristrip to the duoderm patch. Squeeze cheeks again and place a full steristrip across the lip.
How do I care for the NAM appliance?
The appliance should be taken out of baby’s mouth and cleaned daily under running warm water. Before placing the appliance back in your baby’s mouth, you should inspect the appliance for any breakages, rough spots, or changes. Also, check baby’s mouth for any signs of irritation or sore spots. Notify us immediately if something is different.
Do NOT boil the NAM appliance, it will melt.
Do NOT Place the NAM in the microwave.
How often must we come to the hospital?
Unilateral (one-sided) clefts: weekly visits for 3-4 months depending on the severity of the cleft.
Bilateral (Two-sided) clefts: weekly visits for 6-7 months depending on the severity of the cleft.
Your commitment to weekly visit is crucial to achieve the desired results and successful outcome of your baby’s treatment. It is extremely important to us that you feel comfortable at all times during your baby’s NAM experience.
By Dr. Fatimah Alkandiri - Craniofacial Orthodontist
Published: Aug. 15, 2025
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