Nasoalveolar Molding (NAM)

Children’s of Alabama is one of the first hospitals in the state to offer Nasoalveolar (pronounced nay-zoh-al-VEE-uh-ler) molding (NAM). NAM is a nonsurgical method used to reshape the gums, lip and nostrils with a small removable appliance similar to an orthodontic retainer. The plastic appliance is used before cleft lip and palate surgery for your child to help decrease the number of surgeries needed and to reduce the severity of the cleft condition. It can help children with large or wide clefts, and has greatly advanced cleft repair. 

What are the Benefits of NAM?
There are many benefits to this type of pre-surgical cleft lip and palate therapy. 

• It improves the shape and position of the lip and nose. The gums and bone are molded into a better position by reducing the cleft inside the mouth, the gap in the upper lip, and lifting and narrowing the nose to create a smaller cleft to make surgery easier and quicker.
• The removable appliance becomes something like a pacifier, meaning children tend to adapt well to the treatment.
• The therapy also provides the ease of feeding and breathing for the child.
• Using this therapy can reduce the number of surgeries needed to repair the lip and palate.

How dose NAM process work?
The Children’s of Alabama NAM team consists of an orthodontist, plastic surgeon and nurse practitioner who are specially trained in NAM therapy and the surgeries that follow. During and after the therapy, your child will also see other members of the craniofacial team at regular clinic visits as often as needed.

• Initially, patients will need to be referred by their pediatrician or cleft care provider to the Cleft & Craniofacial Center, where our medical team will evaluate and offer NAM to patients who would benefit. They extensively review and discuss treatment options for your child. NAM works to gently direct the growth of your baby’s gums and the shape of their nose during the first few months after birth, when these tissues are soft and easy to mold.
• If possible, a prenatal consultation with our team before your baby is born is preferred to provide the opportunity for the best possible outcome for your family. It allows an opportunity for your child’s condition and treatment options to be discussed and for you to ask extensive questions, and get to know our medical team before your baby is born.
• Following the consultation and custom medical plan, we will perform an initial scan of your newborn baby with digital or traditional equipment depending on your child’s specific needs. We will need to do this as soon as possible, ideally before one week of age. Your baby's NAM appliance then will be ready about one week later after the scan.
• Parents work directly with a Children’s orthodontist during NAM therapy. The orthodontist fits your baby with a custom molding plate that looks like a retainer someone would receive after braces.
• Your baby wears the molding plate 22-24 hours a day, 7 days a week, including when they are feeding. The plate is held in place using small rubber bands that are taped to your baby’s cheeks. Our NAM team will teach you how to change the rubber bands and the tape, and clean the molding plate at home as needed (usually each day).
• Every 1 to 2 weeks for an estimated 12 weeks, the orthodontist makes small changes to the shape of the molding plate to guide the baby’s gums as they grow. Each visit takes 40 to 60 minutes. Families will have regular visits over an estimated 12 weeks
• Once the gap in the gums is small enough, the orthodontist adds a post covered called a nasal stent with smooth, rounded plastic to the front of the molding plate. The nasal stent slides easily into the baby’s nostril. It slowly lifts up the nose and shapes the nostril on the side of the cleft.
• After the NAM method is complete, your child will have surgery to pull their lip together and to further shape their nose, and your baby will no longer need the NAM appliance.

How does NAM feel for my baby?
The molding plate and nasal stent are not painful. NAM does not push or stretch the delicate tissues; it only helps gently direct their growth. 

After getting used to the plate for a few days, many babies seem happier wearing it than they do without it. This may happen because the plate acts as a palate or the roof of the mouth. It keeps your baby’s tongue from pushing into the cleft, and it makes feeding easier for your baby.

For more information or to schedule a consultation, please contact the Plastic Surgery office at 205-638-9369.

Clinic Location
McWane Building- Clinic 14
1600 7th Avenue South
Birmingham, AL 35233
(Park in the 7th Avenue Deck)

Phone:  205-638-9369

Other Helpful Resources

• AboutFace
• Changing Faces
• Children's Craniofacial Association
• Cleft Advocate
• Cleft Palate Foundation
• FACES: The National Craniofacial Association
• Family Voices
• Parents Helping Parents
• Support for Families of Children with Disabilities
• Woodbine House Special Needs Books