Most patients with orofacial clefts can be satisfactorily treated by the late teen years. However, despite treatment advancements, the reconstruction of the cleft nose remains a challenge. Since 1992 we have adopted a non-surgical protocol prior to lip closure in our patients with cleft lip and palate, to mold the misshapen nasal structures observed at birth.
This process of pre-surgical nasal and maxillary orthopedics is known as Nasoalveolar Molding (NAM). Its purpose is to improve the symmetry of the nasal cartilages, elongate and upright the columella (the tissue between the nostrils) and reduce the width of the gum and palate. In patients with bilateral cleft lip and palate NAM is also utilized to decrease the prominence of the central portion of the lip (premaxilla) before lip surgery.
With this approach, the severely distorted cleft nose is molded into a nose with close to normal form and symmetry. The newly shaped nose and narrower cleft facilitate surgery and assure improved results without additional nasal surgery in the infant or childhood years. In addition, it reduces the number and complexity of operations required to establish a functional and aesthetic nose in the adolescent years.
The best time to initiate this treatment is within the first 2-4 weeks of life, as the nasal cartilages can be molded permanently into better form. In older patients, molding is not as effective since the nasal structures are more elastic and resist permanent change. Therefore, patients need to be referred early to significantly benefit from this approach.
We strive to provide the best and most updated treatment approaches to patients with orofacial clefts under expert and caring management. If you believe that your baby, friend’s baby, or the newborn patient may benefit from NAM before lip surgery, or you have any questions concerning the management of patients with orofacial clefts, please contact our office.