cleft care at UK HealthCare

Reader question about the NAM device

Question

Joyce K. asks, “Does your team use the NAM device pre-surgery?”

Answer

Nasoalveolar molding (NAM) is a technique to help mold the nose and alveolar segments in a child prior to cleft lip repair. This can be helpful with wider clefts. My experience with them in my year of fellowship training have generally been positive, however it does require a fair amount of maintenance, care, and usually weekly to biweekly follow up appointments. If the child is unable to tolerate the device, or if it is difficult for the child and parent to maintain, NAM has the potential to be quite stressful.

We do not routinely offer this service here for several reasons.

  1. This is an orthodontic appliance and traditionally managed by an orthodontist. Unfortunately at the University of Kentucky, there is not an orthodontist on staff who does nasoalveolar molding, however, I do know of an orthodontist in Lexington who has done a fellowship in NAM and I’d be more than happy to put you in contact with her.
  2. If the child or parent are unable to complete the NAM protocol, then there may be unwarranted feelings of “guilt” or “not being able” to do what is necessary. There can be feelings of being a “bad parent”. THIS IS NOT TRUE! NAM can be quite difficult depending on the child and social circumstances, as well as the weekly to biweekly scheduled visits. Because of this potential dynamic, I do not tout or pressure any family to do NAM. This leads us to the next question, how effective is NAM.
  3. NAM works to readjust the nose and even out the alveolar ridges. But the main question is whether this continues to be effective or any different than non-NAM treated children over time; basically the question is whether this makes a difference in the long term. Only several institutions have enough long term data to support the superiority of NAM, and there is argument that their experience is difficult to duplicate.

Personally I feel nasoalveolar molding allows a very active approach to the 1st several months life of the child prior to his or her cleft lip repair. How a family adjusts to this can range from adding more stress to the parent and child, or it may be exactly what the parents want since they can actively alter their child’s cleft. Whether this makes a difference in less wide clefts I cannot answer that, although my gut feeling is that is does not.

Does it produce a “nicer” cleft lip repair? My experiences with NAM suggest that if you have a great NAM treatment, but a less than adequate repair, you will have an inadequate repair. If you have no NAM or partially completed NAM protocol, but an excellent repair, then you have a child with an excellent repair, and this is what I focus on with every one of my cleft children. Once again, I stress this is a my own humble opinion on the NAM from personal experience.

James Liau, M.D.
Assistant Professor
Division of Plastic Surgery
University of Kentucky