How does nasoalveolar molding or NAM work?

To start NAM, parents work with an orthodontist. Within the first couple of weeks after birth, babies are fitted with a custom-made molding plate that looks like an orthodontic retainer. The device is attached with a small orthodontic rubberband that is taped to the baby's face.

The molding plate causes no pain and after the first few days the plate usually doesn't bother babies at all; it's an accepted part of their face.

Unlike some older techniques, the molding plate does not push or stretch the delicate tissues; it only helps gently direct the growth of the gums.

The baby wears the molding plate 24 hours day, seven days a week, including when they are feeding. The parents change the tape and clean the molding plate daily as needed.

After the baby has worn the molding plate for a week, the orthodontist slowly adjusts the shape by sculpturing the plastic. Each adjustment is very small, but it starts to guide the baby's gums as they are growing.

Adjustment of the molding plate is done by the orthodontist weekly or every other week depending on progress. Each appointment takes 40-60 minutes.

Once the cleft gap in the gums is small enough (around one quarter-inch), a post is attached to the molding plate and is inserted in the nostril. This post is then slowly adjusted to lift up the nose and open the nostril.

By the time of the surgery, the nose has been lifted and narrowed, the gap in the gums is smaller and the lips are closer together.

A smaller gap means less tension when the surgeon closes the cleft. In our experience this results in a better final result than if NAM had not been done.