During your first visit, we will evaluate the cleft’s type, size and severity, and the need for taping and Nasoaleveolar Molding (NAM)
Dr. Fawzi Alqatami
Diplomate of the American Board of Orthodontics
Ministry of Health, Kuwait
Right after your baby is discharged from the hospital, the team will need to meet you and your baby. During our first visit, we will evaluate the cleft’s type, size and severity. Cleft type means is it an incomplete cleft? Does it involve just one structure such as nose only? Lip only? Gums only? Or only the palate? Or is it a complete cleft that involves the nose, lip, gums and palate? Once this is determined, we would need to know if it is on one or both sides. The team will take a closer look and examine your child for the above and let you know the exact diagnosis. We will also check if there are any additional problems other than cleft and inform you, if needed.
The first usual step in your child’s care is lip taping. It involved using a special type of medical grade tape to be applied on your child’s cheeks and lips to approximate the soft tissue (skin). The instructions will be clearly given to your family on your first visit. If the cleft extension is minor and only limited to the lips, this intervention is usually sufficient.
In more severe cleft cases and after confirming the exact type of the cleft, we will need to determine if your child will need to get a dental impression of his palate. The reason for this impression is to make a gypsum (stone) model which will be the exact replica of your child’s cleft palate. This model will be used to fabricate a “molding plate” made out of dental acrylic, which is like a denture for baby. The reason behind this molding plate is to help us in moving the separated cleft segments closer to enable the plastic surgeon to connect those segments better during your child’s first surgery! So our job here is to make the surgeons’ job easier by trying to normalize and approximate the cleft segments.
In case the cleft involves the nose, the same molding plate that was used to approximate the segments, will have a nasal extension. After the gap between the palatal segments is reduced to less than 5 mm, a wire will be attached to the molding plate. This “nasal wire” will extend into your child’s nose. The comfort of your child will be ensured by covering this nasal stent with soft acrylic in the shape of a kidney. The aim of the nasal stent is to elevate the collapsed nasal structures on the cleft side. In cases where we have clefts on both sides of the nose, two nasal stents will be provided! This will allow us to achieve nice elevation of the nose to change its shape and try to make it as normal as possible before your child’s first surgery.
Now you may ask how long will this process take? On average, if you child has a cleft on one side, it will usually take approximately 3 months, and in cases where it is on both sides, it can take up to 6 months. Once your child is done with this treatment phase, we will refer you to your plastic surgeon.
Clear instructions on how to use the molding plate and the nasal stent will be given to you in detail.