Nasoalveolar Molding

What is Nasoalveolar Molding?

Nasoalveolar Molding (NAM) is presurgical treatment used to optimize the outcome of primary lip and nose surgery in children with cleft lip and palate. NAM does this by reducing the severity of both the hard and soft tissue cleft deformity, providing the surgeon the best possible situation in which to perform the surgery.

The "N" in NAM comes from "naso", referring to the nose.The "A" in NAM stands for "alveolar", which is the name of the gum pad, the bone that will eventually support the teeth.And the "M" in NAM refers to "molding", which means to guide or determine growth and development.

How does NAM work?

NAM is frequently used for both unilateral clefts (clefts on one side only) and bilateral clefts (clefts on both sides). The first aim of NAM is to reduce the width of the cleft in a unilateral cleft and to center and retract the premaxilla (the bone in which the front teeth are anchored) in a bilateral cleft.Following alignment of the gum pads, the nasal stent is added to the appliance. For unilateral clefts, the goal is to make the nostrils symmetric, as the nostril on the side with the cleft is usually flat. For bilateral clefts, the goal is to create more tissue between the nostrils, called the columella, which is usually quite deficient and a challenge for surgeons to repair without creating more scar tissue and performing multiple surgeries.

NAM Series

To start NAM, an impression of the upper jaw is made. This is done in the clinic and takes about 10 minutes. The NAM appliance is ready for delivery 1-2 weeks later.NAM requires an adjustment every 1-2 weeks.After alignment of the gum pads, which takes about 2 months, the nasal stent is added.Nasal molding usually takes 2-3 months, after which the infant is ready for the primary surgical repair.

What is your experience with NAM?

Dr. Judah Garfinkle, who performs NAM at OHSU, is an orthodontist who completed a 2-year fellowship at NYU with the inventor of NAM, Dr. Barry Grayson. Dr. Garfinkle has authored three book chapters and multiple scientific research articles on NAM and lectures widely on the use of NAM across the country.

What type of NAM is done at OHSU?

We offer NAM for both unilateral and bilateral clefts at OHSU. After your baby is born, providers will look at your baby's cleft and decide whether NAM is likely to provide benefit.NAM requires frequent visits to our clinic for adjustments to the device, and we will talk with you about whether this will work for your family.