Nasoalveolar Molding, aka, The NAM

We were introduced to Nasoalveolar Molding (NAM) when Noah was 2 weeks old. We went to see the dentist and the surgeon for the very first time after his birth. The dentist explained that he would take impressions of Noah’s mouth to make a retainer type of mouth piece, called the NAM, that would aid to improve the outcome of both cleft repairs. This is started so soon after birth because the baby still has immature cartilage and it is still quite malleable at this stage. Once the NAM is made and fitted it will help to expand the tissue before surgery. There are also wires added that will help to correct the shape of the nose and the tip of the nose. Using this prior to surgery can help the results and give less of a chance that a lip or palate revision will be needed. In Noah’s case, with his unilateral cleft lip and palate, he received his NAM at 3 weeks old. It was an adjustment, but it also really helped him eat better since the NAM created a full palate. It worked so well that his 3 and 6 year old sisters had no problems feeding him! We used denture adhesive to keep it in his mouth, took it out 2x a day for a cleaning then put it in again. He wasn’t always fond of it and I admit that it was hard for me to be on NAM duty at first. But eventually I got used to the new routine and found that it wasn’t as bad as it had seemed in the beginning. His NAM had no wires the first 2 weeks. Then one wire was added to the cleft side of his nose. Shortly after the second wire was added.

Working hand in hand with the NAM is the taping of the cleft lip using steri strips, along with a special glue. Taping works much like the NAM does, it expands the tissue in the lip. In Noah’s case, his cleft lip had a large gap at birth. However after 4 months of taping, his lips would then touch easily without the tape. Taping was a messy job and one that required a lot of patience in the beginning. But practice helps and we soon had a system down that worked for us. We called Noah’s taping his “whiskers” and his NAM became his “teeth”. Having other children, we needed to find a good name for what we were doing daily to their brother. Soon both the girls were experts at explaining to their young friends why Noah had to wear his “whiskers” every day or why he had special “teeth”. We feel the NAM worked wonders for Noah, we are very happy with the results! Not all cleft teams choose to use a NAM and those children who don’t also have fantastic results post surgery! So it does come down to preference and what the team believes is best for their patients. Children’s Hospital of Michigan uses the NAM whereas the team at The University of Michigan has chosen not to. There is no right or wrong in this, just different ways to accomplish one result.

Once Noah had his lip repaired his NAM with the wires was retired then replaced with a new NAM that was without the wires. Post lip repair Noah did wear nasal stints for about 14 weeks. The nasal stints are soft, plastic and cone shaped. The wider part of the cone is at the nasal opening, with the thinner opening inside the nose. To hold them in place we had to punch holes in a wide steri strip, then apply that over the nostrils. This aided in keeping his nostrils shaped properly through the healing process post lip repair. To begin with, Noah wore the stints pretty much all day. Eventually though, it was only necessary part of the day so we could just wait until bedtime to put the stints back in.