NAM stands for nasoalveolar molding. It is a procedure done by dentists prior to surgical repair for cleft lip and palate because surgical repair alone cannot correct the multiple problems encountered with the deformities that result from clefts of the lip and palate. A difficult challenge for the surgeon is the creation of an aesthetically acceptable correction of the deficient columella (middle part of the nose) and the deformity of the nasal cartilages. The NAM technique takes advantage of the malleability of immature cartilage of the nose and the ability to non-surgically construct the columella through the application of tissue expansion. Pre-surgical infant orthopedics (molding) has been employed since the 1950's for correction of cleft lip and palate, but it does not take into account the deformities of the nasal cartilages and columella.. By the addition of a nasal portion to the molding plate, we can now correct the nasal tip, the base on the affected side, as well as the position of the philtrum and columella.
Timing is very important. The ideal time to begin NAM is 1-2 weeks after birth. In a hospital setting, an impression is taken of the infant fully awake. A molding plate is then fabricated and inserted. The infant will wear the molding plate 24 hours a day for approximately 4-6 months. The molding plate causes no pain and is attached with small rubber bands taped to the face.
Adjustments to the molding plate/nasal portion are done weekly, or every other week, depending on the progress. Each adjustment is very small, but it starts to guide the baby's gums, lip, and nasal cavities as they are growing.
At the conclusion of nasoalveolar molding (in unilateral cases, it is approximately four months and in bilateral cases, six months), the nasal cartilages, columella, philtrum, and alveolar segments should be aligned to facilitate the surgical restoration of normal anatomic relations.
The cleft palate team consists of surgeons, pediatric dentists, orthodontists, prosthodontists, psychologists, therapists, translators, geneticists, case managers, and for some of our older patients, even make-up artists. The children served by this team have all made a wonderful recovery. Many of the services provided by the team are considered to be "non-essential" by insurance providers and other organizations. Consequently, in order to continue to provide these very valuable services to the children, we must look for generous donors for the funds needed to support this important project.
The NAM team currently sees approximately twenty infants each year at Childrens Hospital Los Angeles. The cost per infant is approximately $4,000. We hope you will consider supporting our efforts by contributing to the costs to treat these infants.
