Nasoalveolar Molding for Infants Born with Clefts of the Lip, Alveolus, and Palate

Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Nasoalveolar molding represents a paradigm shift from the traditional methods of presurgical infant orthopedics. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages in unilateral, as well as bilateral, clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The Nasoalveolar Molding (NAM) technique utilizes wire and acrylic nasal stents attached to an intraoral denture. This appliance is used to mold the nasal cartilages, premaxilla, and alveolar ridges into normal form and position during the neonatal period. In effect, this presurgical management of the cleft infant is intended to reduce severity of the oronasal deformity prior to surgery. This technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically elongate the columella in bilateral cleft lip and palate through the application of tissue expansion principles. This is performed by gradual elongation of the nasal stents and the application of forces that are applied to the lip and nose. Utilization of the NAM technique has eliminated surgical scars associated with traditional columella reconstruction, has reduced the number and cost of revision surgical procedures, and has become the standard of care in this Cleft Palate Center.