The boon of nasoalveolar molding (NAM) treatment in early management of cleft lip and palate patients

Abstract

Patients with different types of labio-maxillo-palatine clefts go through a lifelong series of multidisciplinary therapeutic procedures; this “journey” sometimes begins prenatally and extends into adulthood. Presurgical orthopedic treat­ment (PSO) is one of the first stages of this therapeutic plan. The nasoalveolar molding technique (NAM) is a new method of approach, from the field of pre-surgical or­tho­pe­dics, in­sti­tu­ted at a very young age (infant), and aims to reduce the initial severity, the level of alveolar cleft and/or the degree of nasal deformity. This approach enables the primary surgical restore of the nostril and lip to heal beneath minimum ten­sion, thereby reducing scar for­ma­tion and enhancing the esthetic result. The NAM tech­nique is the non-surgical, pas­sive method of bringing the gum and lip together by re­di­rec­ting natural growth forces. NAM has been shown to be an effective adjunctive the­ra­py for reducing pain, de­for­mity and the level of soft tissue tearing before surgery. This paper reviews the basic principles of NAM therapy, the different types of devices used in this therapy, the protocol followed and a critical eva­lua­tion of the advantages and disadvantages of this tech­nique. As an example, finally, we present the case of an infant with a unilateral labio-maxil­lary cleft, to which a NAM-type orthopedic device was applied with the aim of reducing tensions at the level of the tissues with the de­fect, to minimize the extent of the sur­gi­cal intervention and to minimize the risk of postsurgical re­trac­tile scars. World­wide, the authors of various studies agree on the positive out­come of NAM for better aesthetics after surgical repair of cleft lip and palate (DLP). However, what still remains, at this moment, unfounded equivocal is whether the pre-sur­gi­cal reduction of the cleft sizes and the modeling ma­ni­pu­la­tion of the nasal complex benefit our patients in the long term. Despite a relatively small amount of high-level evi­dence, NAM appears to be a promising technique that de­serves further research.