Nasoalveolar Molding (NAM)

The treatment article in summary is named "Presurgical Nasoalveolar Moulding Treatment in Cleft lip and Palate Patients," and the authors of it are Barry H. Grayson and Pradip R. Shetye.  The article depicts a new pre-surgical molding technique for cleft lip and cleft palate called the Nasoalveolar Molding (NAM) technique.  This method is used as a way to mold the initial cleft alveolar and nasal cartilage malformations, which other previous pre-surgical molding methods did not encompass in their treatments.  This treatment device consists of a molding plate and a nasal stent.

The overall goal of the NAM is to reduce severity of the original cleft, and in turn, make it easier for a surgeon to achieve better repair of the other affected areas, namely the alveolus, lip, and nose.  Additionally, the NAM has eradicated the need for surgical columella reconstruction and scar tissue often associated with such.  The NAM has been shown to significantly improve the surgical outcome of the primary repair in cleft lip and palate patients, when being compared to other presurgical orthopedic techniques.

The authors begin by describing the NAM appliance creation and fitting process.  First, an impression using silicone material is made of the oral cavity of the infant.  This impression is done within the first week of birth.  The impression is then poured into a dental stone to make a fitting cast.  From there, the plate is created, and a retention button is placed in the front part of the plate.  Once ready, the appliance is inserted into the oral cavity, using tape on the outside cheeks, and orthodontic elastic bands inside of the mouth.  Parents are told to keep it in all the time, even while feeding, and to take it out once daily to clean it.  The infant is then to be seen once a week to make adjustments to the molding plate.  Once the alveolar gap is reduced by 5mm, the nasal stent part of the appliance is added.  Finally, attention is focused on nonsurgical lengthening of the columella. This is accomplished by addition of a horizontal band of denture material to adjoin the left and right lobes of the nasal stent. 

Once the NAM has molded the areas of deformities enough, surgery is to then be completed at around 3-4 months of age.  They note that bilateral cleft molding often takes 1-2 months longer than unilateral clefts do, and severity of clefting also plays in a role in how long the molding process takes.  The authors then briefly touch on complications of the NAM device; mainly irritation to the oral mucosa, nasal mucosa, or gingival tissue.

The authors end with a discussion of their findings. They reiterate the benefits of the NAM technique, namely making surgical repair easier and improved reconstruction results overall.  They also touch on other possible benefits not mentioned previously, such as some patients using NAM not requiring bone grafting or less extensive bone grafting being necessary.  Their closing remarks emphasize the substantial benefits and efficacy of the NAM technique for cleft lip and palate patients.

References

Grayson, B.H., & Shetye, P.R. (2009). Presurgical nasoalveolar moulding treatment in cleft lip and palate
     patients. Indian Journal of Plastic Surgery, 42(1), 56. doi: 10.4103/0970-0358.57188.