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Cleft Palate

Cleft Lip and Palate Treatment

Roseman Dental & Orthodontics has been performing Nasoalveolar molding or NAM, to treat cleft palate and cleft lip at its Henderson clinic since 2012. The College has collaborated with the Nevada Early Intervention Services Cleft Lip and Palate Team since 2008. Our team consists of all the medical specialists necessary for a child’s care and development including pediatric dentists, plastic surgeons, pediatricians, ENT, audiologists, nutritionists, and speech pathologists.

See recent Las Vegas Review-Journal article about one of Roseman Dental & Orthodontics’ patients by clicking HERE.

If you are expecting a child to be born with cleft palate or lip, please contact Roseman Dental at 702-968-5222 or Contact Us.

What is Nasoalveolar Molding (NAM)?

Nasoalveolar molding, or NAM, is a nonsurgical way to reshape the gums, lip, and nostrils with a plastic plate before cleft lip and palate surgery. Pre-surgery molding may decrease the number of surgeries a child needs because it makes the cleft less severe. NAM is used mainly for children with large or wide clefts and has greatly changed cleft repair.

  • It reduces the cleft inside the mouth.
  • It reduces the gap in the upper lip.
  • It lifts and narrows the nose.

Surgery takes place after the molding is complete when the child is around age four to six months.

Previously, a child with a large cleft needed many surgeries between birth and age 18, putting the child at risk for psychological and social challenges. The first surgery pulled the lip together, the second improved the position of the lip, two more would shape the nose, then another — often including a bone graft — would close the palate, and so on.

With NAM, orthodontists at Roseman University College of Dental Medicine can reduce a large cleft in the months before surgery. NAM also improves the shape and position of the lip and nose. With a smaller cleft, there is less tension when the surgeon closes the cleft. Molding the lip and nose in advance can mean less reshaping is needed during surgery. With a better result from the first surgery, a child may need fewer surgeries later in childhood.

How does NAM Work?

NAM works by gently directing the growth of a 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.

Parents work with orthodontists at Roseman Dental & Orthodontics during NAM therapy. The orthodontist fits the baby with a custom molding plate that looks like a retainer you would get after braces. The baby wears the molding plate 24 hours a day, seven days a week, including when they are feeding. The plate is held in place using denture adhesive.  Medical tape is then placed from cheek to cheek over the cleft to help mold the bones inside the mouth as well as the lips.  Parents, taught by the orthodontists, change the tape and clean the molding plate at home as needed (usually three to four times each day).

Every one to two 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 about 40 to 60 minutes.

As the tape is closing the bones, a metal prong with a soft material covering inserts into the nose to from the molding plate. This post (called a 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.  This stent is removed approximately one week before the lip and nose repair surgery.

How does NAM feel for the baby?

The molding plate and nasal stent are not painful. After getting used to the plate for a few days, many babies seem happier wearing it than they did without it. This may happen because the plate acts as a palate (roof of the mouth). It keeps your baby’s tongue from pushing into the cleft, and it makes feeding easier for the baby.

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