The Cleft Palate and Craniofacial Institute at St. Louis Children’s Hospital is one of few centers in the Midwest with expertise in nasoalveolar molding (NAM) to correct cleft lip and palate deformities. 

NAM DeviceThe NAM procedure uses an orthodontic device in the mouth to help shape and improve the position of the nose.  This makes it easier for plastic surgeons to form a symmetric lip and nose after one procedure, achieving a more natural appearance. Depending on the patient, the NAM procedure may eliminate the need for a secondary surgery involving lip revisions and nasal reconstruction.  The technique improves results in both unilateral and bilateral cleft deformities. 

The NAM procedure

NAM ProcedureNAM begins as soon as possible and as early as the baby’s first week of life.  A pediatric dentist makes a mold of the newborn’s mouth.  This mold is used to create the NAM device, which is similar to an orthodontic retainer. 

Except for cleaning, the baby wears the device 24 hours a day.  Its shape gently directs the growth of the upper jaw and gums.  During this time, the baby visits the pediatric dentist every week in order to make adjustments to the NAM appliance. 

NAM PatientOnce the cleft has closed to approximately 5 millimeters, the dentist adds a wire with an acrylic tip that fits into the nose.  The acrylic tip gently lifts the nose, while at the same time tape connected to the appliance pulls down on the nose.  The stretching raises the flattened, cleft side of the nostril.

This process gradually improves the baby’s appearance and improves the position and shape of the nose. 

NAM Patient, before and after

Frequently Asked Questions...

How long will my baby wear a NAM device?

Babies with unilateral clefts usually wear the NAM device for about three months; those with bilateral clefts may need the device for up to six months. Once the plastic surgeon and dentist agree the best results possible have been achieved, the babies are then scheduled for their first corrective surgery.

Is my baby a candidate for the NAM procedure?

The determining factor as to whether a baby is eligible for NAM is the parents’ commitment to dedicating the time and patience needed for the technique to succeed.  Parents must clean the device, tape it in place, deal with skin or mouth irritations, and make weekly trips to the dentist.  For parents who are able to devote the time and effort necessary, NAM provides the best results.