Nasoalveolar Molding - NAM for Cleft Lip and Palate

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Nasoalveolar molding (NAM) is a pre-surgical, custom-made orthopedic appliance that brings together the two sides of a cleft lip or palate and narrows a wide cleft. It also forms and shapes the nose and facial structures to provide a more symmetrical appearance.  Pedro Santiago, DMD, a Duke craniofacial orthodontist, helped develop the NAM technique in the 1990s. His expertise with the NAM device ensures your child experiences the best possible aesthetic and functional cleft surgical results. NAM can also reduce or eliminate the need for additional surgical procedures.

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The NAM Device Process

The NAM device can be beneficial for a cleft on one or both sides of the face. It works by gradually bringing the two sides of the cleft together and closing the gap in the gum line. It also molds the nose to create symmetry.

NAM Should Start Within First Weeks of Life
Shortly after birth, our craniofacial orthodontist and pediatric plastic surgeons evaluate your infant. If your child will benefit from NAM, a dental impression is taken of your infant’s mouth in the clinic. The process takes a few minutes and is done while your baby is awake. The impression is used to create a custom acrylic device that resembles an orthodontic retainer. The device is placed in your newborn’s mouth and worn for 24 hours a day for the recommended treatment time. Depending on the type and severity of your child’s cleft, the NAM appliance may remain in place for a few weeks or up to six months.  

NAM Is Not Always the Answer
NAM may not be necessary for incomplete and/or narrow clefts. Some families may choose not to pursue NAM for personal reasons. We support your family's choice and welcome you to work with our team. Cleft surgery can proceed without NAM.

We Train You to Place, Remove, and Clean the Device
You and your baby’s caregivers will be trained to carefully place, remove, and clean the device. You’ll also learn how to manage any skin or mouth irritations that may occur. Infants may experience some initial discomfort wearing the NAM device but will get used to it quickly.

We Offer Feeding Support
Our speech pathologists work with you and your baby immediately after the NAM device is placed. This is important because some babies have difficulty adjusting to feeding with the new device. However, some babies’ feeding improves with the extra support of the NAM plate, especially if the cleft is very wide. Each baby and situation is different and our speech pathologists can provide education, guidance, and encouragement as your baby begins to feed with NAM. Additional sessions or telephone calls can be arranged to provide more support as needed. We help you every step of the way.

Regular Visits Ensure the Device Is Working
You will bring your baby to our orthodontic office every one to two weeks so we can monitor your baby’s progress and make adjustments. If needed, a small stent is placed in the nose to improve symmetry and shape. Our doctors and speech-language pathologists offer advice between visits.

Noticeable Improvement Over Time
You will see a noticeable difference as the two sides of the cleft come together and the facial structures straighten. Once the best possible results are achieved, your baby will be scheduled for surgery to close the remaining cleft. The NAM device optimizes your baby’s chances of experiencing the best possible outcome in one surgery. It simplifies the surgery, produces better aesthetic and functional results, and can reduce the need for additional surgeries or revisions later on. The goal of our team is to perform the fewest surgeries and provide the best possible result.  

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The Role of the NAM Device in Your Child's Treatment Plan (Video)

Watch this video to learn more about Duke’s approach to cleft surgery and the role the NAM device can play in your child’s treatment plan.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Why Choose Duke

Duke Cleft and Craniofacial Team Includes World-Renowned NAM Expert
Duke’s craniofacial orthodontist helped develop the NAM device in the 1990s. His vast experience with the device ensures it is used successfully and effectively.

Your Child Is in Experienced Hands
Our team of professionals helps with every aspect of your child’s care. Their care team may include a pediatric plastic and craniofacial surgeon, an oral surgeon, a craniofacial orthodontist, an ear, nose and throat doctor, audiology and speech therapy providers, a clinical social worker, and others. The Duke Cleft and Craniofacial team meets the standards set by the American Cleft Palate-Craniofacial Association. This means our team functions in a coordinated and effective manner that complies with the standards of this nationally recognized organization.

Our Dedicated Team Coordinator Works Closely with You
Our team is managed by a dedicated team coordinator who ensures that your child’s care is provided in a timely, coordinated manner. The team coordinator can be contacted directly for any questions or needs at 919-684-3815.

We Support You Every Step of the Way
Our team supports you through every step of this process. We can connect you with families whose children received NAM treatment at Duke. In addition, our social worker will listen to you, provide emotional support, and share in your excitement as you get to know your newest family member. Our social workers also talk through your child’s developmental needs, offer insight and reassurance about raising a child with a craniofacial difference, and provide information about financial assistance and other resources available at Duke and in our community.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 10 pediatric specialties by U.S. News & World Report for 2024–2025.

This page was medically reviewed on 10/27/2022 by