A nasoalveolar molding (NAM) appliance (Figure 1)is a treatment used for unilateral and bilateral cleft palate babies. Its purpose is to reduce the severity of the cleft in the upper gum pads or alveolar ridges and to reduce the deformity of the nose . Many times, babies with cleft lip or palate have no columella which is the middle part of the nose. The treatment has been shown to be beneficial in preparing the baby for surgical repair of cleft palate and lip. The procedures takes advantage of the malleability of the immature cartilage of the nose and the ability to use tissue expansion to construct the columella (middle part of the nose). Often times, the nasal portion of nasoalveolar molding corrects the nasal tip, the nasal base of the affected side, the philtrum, and columella. It involves making an impression of the upper arch within the first week of life in a hospital setting. The baby is seen weekly to make adjustments to the appliance. Total treatment time for unilateral cleft cases is approximately 2 to 3 months (Figure 2).
For bilateral cleft cases, it can be approximately 4 to 6 months, depending upon the severity of the cleft. Nasoalveolar molding is useful in shaping the philtrum which is the upper part of the lip. There are contraindications to treatment which the doctor will review with you. Dr. Betsy Davis is certified in nasoalveolar molding by the Institute of Reconstructive Plastic Surgery at New York University School of Medicine.