Nasoalveolar Molding Research Articles

The role of primary surgery in the management of orofacial clefting.

Primary cleft surgery refers to the planned surgical procedure(s) necessary to reconstruct an orofacial defect according to a specified protocol; in the context of a unilateral cleft lip and palate, this would include lip repair (with vomer flap closure of the hard palate), subsequent repair of the residual soft palate cleft and finally, the alveolar bone graft. This paper will provide an overview of the goals of primary surgical reconstruction, including the utility of pre-surgical orthopaedic techniques, including nasoalveolar moulding. The surgical methods of primary lip repair in both unilateral and bilateral clefts will be outlined and the concept of a primary rhinoplasty will be introduced. The principal techniques of cleft palate reconstruction will be delineated for a variety of cleft phenotypes. The final element of the primary reconstructive sequence is the alveolar bone graft using cancellous bone harvested from the iliac crest at approximately 8-10 years of age. The role of optimising oral hygiene prior to bone grafting cannot be over-emphasised and the utility of pre-surgical orthodontic arch expansion is also discussed. In the UK, bone graft outcomes are audited using the Kindelan score, which is evaluated from the six-month postoperative upper standard occlusal radiograph.

The Effects of NAM on the Symmetry of the Face and Maxillary Arch in Babies With Unilateral Cleft.

The study aimed to evaluate the effect of nasoalveolar molding (NAM) therapy through reverse engineering, or its absence, to obtain symmetry of the face and maxillary arch. Twenty-six babies with unilateral cleft lip and palate received treatment with NAM, and 12 babies with unilateral cleft lip and palate without presurgical orthopedics (control group). Patients were molded and photographed in 2-stages: the first month of life (T1/pre) and after the use of NAM/before the cheiloplasty (T2/post). In the digital models, the analyses performed were arch perimeter, arch length, and labial frenulum angle. The photographs allowed us to analyze nasal width, mouth width, columella angle, and nostril area. The results demonstrated that there was an increase in arch perimeter and arch length in control and NAM groups in the T2 period in comparison to T1. Labial frenulum angle was reduced in the NAM group compared to the NAM-T1 and control-T2 periods. Treatment with NAM yielded a reduction in nasal width in the period of T2 compared with T1. Columella angle was enhanced after NAM use in T2 and, was different from control group. The nostril area was reduced in the NAM group in T2 compared with control group. Nasoalveolar molding therapy reduced the labial frenulum angle, contributing to a reduction in the extension of the cleft. The NAM protocol improved facial symmetry, mainly through nasal effects, whereas the absence of orthopedic therapy yielded a commitment to the face and maxillary arch symmetry.

Design of Unilateral Complete Presurgical Nasoalveolar Molding (PNAM) Corrector Based on Feature Points Extraction of Complex 3D Surface

Cleft lip and palate is a congenital maxillofacial deformity. Unilateral complete cleft lip and palate is one of the most common clinical types. Nasal alveolar molding (PNAM) is a recognized strategy for the treatment of cleft lip and palate. However, the current design of PNAM devices mainly relies on the subjective experience of doctors. The purpose of this paper is to describe the design and manufacture of a new computer-aided design appliance, which can be applied to the presurgical nasoalveolar molding of unilateral complete cleft lip and palate, eliminate individual differences, and improve production efficiency. In this paper, seven feature points on the healthy side and the affected side are extracted by the method of Gaussian curvature and ridge line extraction, and the healthy side rotation and built-in model are designed by using these seven feature points, which can quickly generate eight treatment stages of PNAM. The correction effects of the PNAM appliance designed in this paper were compared with the original maxillary model and the clinical PNAM appliance (hand-made by subjective experience) from the aspects of alveolar fissure width and symmetry. The PNAM appliance designed in this paper can effectively improve the symmetry of patients with unilateral complete cleft lip and palate (morphological similarity: t = 3.250, p ≤ 0.01; length similarity: t = 1.559, p = 0.150) and reduce the width of alveolar cleft (t = 8.330, p < 0.01). This can fully achieve the therapeutic effect of PNAM appliances prepared by experienced doctors and is more efficient. The method based on complex 3D surface feature point extraction can provide the basis for the design and evaluation of a unilateral complete PNAM correction model, improve the design and production efficiency of unilateral complete cleft lip and palate appliance, eliminate the design problems caused by individual differences, and reduce the burden of doctors.

Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care.

Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded. Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027). Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.

A Modified Naso-Alveolar Molding Device for Unilateral Cleft Lip and Palate

Objective: Naso-alveolar-molding(NAM) is used to reshape the nasal cartilage and mold the maxillary alveolar arch before surgical cleft/lip repair. The study aimed to modify the conventional-NAM-device to lessen the severity of cleft lip/palate deformity and make the overall procedure simpler and beneficial, with fewer hospital recall visits.Methods: Sixty-six patients with unilateral cleft lip/palate were selected: 21 males and 12 females were fitted with a conventional-NAM-device, whereas 18 males and15 females were fitted with a modified-NAM-device. The inter-alveolar gap ranged between (14.5 and 13.5)mm. A presurgical-NAM-device was applied in the second week after the birth. Standardized parameters of cleft lip/palate were measured on the cast. Nostril width, columellar height, and columellar angle were measured on photographs. The number of recall visits was recorded. The modified device was similar to the conventional-NAM-device. However, the nasal stent was made of acrylic and separated from the plate. The thickness of the acrylic stent ranged from 10 to 3mm. The thicker and heavier acrylic was placed on the bigger arch side, and the thin part was placed on the small arch side.Results: A difference was observed between the conventional and modified device in the time taken to reduce the inter-alveolar-gap. Additionally, with the modified device there were fewer recall visits to the hospital. Furthermore, when the conventional NAM was compared with the modified device, the latter showed a significant improvement regarding the patients’ outcome (One-way-ANOVA or Kruskal-Wallis).Conclusions: The modified device is an effective and non-invasive device for accelerating the alignment of the alveolar segments to create the foundation upon which excellent lip/primary nasal surgery results can be achieved. This modification made the procedure more beneficial and simpler for the patient and parents. At the same time, recall visits were reduced by half when compared to those required for the conventional device.

Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding and Gingivoperiosteoplasty to Facial Maturity.

The long-term effects of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. The authors report clinical outcomes of facially mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP). A single-institution retrospective study of nonsyndromic patients with complete BCLP who underwent NAM between 1991 and 2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained. The total number of cleft operations and cephalometric measures was compared with a previously published external cohort of patients with complete and incomplete BCLP in which a minority (16.7%) underwent presurgical orthopedics before cleft lip repair without GPP. Twenty-four patients with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent alveolar bone graft, and nine (37.5%) required speech surgery. The median number of operations per patient was five (interquartile range, two), compared with eight (interquartile range, three) in the external cohort ( P < 0.001). Average age at the time of lateral cephalogram was 18.64 years (1.92). There was no significant difference between our cohort and the external cohort with respect to sella-nasion-point A angle (SNA) [73 degrees (6 degrees) versus 75 degrees (11 degrees); P = 0.186] or sella-nasion-point B angle (SNA) [78 degrees (6 degrees) versus 74 degrees (9 degrees); P = 0.574]. Median ANB (SNA - SNB) was -3 degrees (5 degrees) compared with -1 degree (7 degrees; P = 0.024). Twenty patients (83.3%) underwent orthognathic surgery. Patients with BCLP who underwent NAM and GPP had significantly fewer total cleft operations and mixed midface growth outcomes at facial maturity compared with patients who did not undergo this treatment protocol. Therapeutic, III.

Comparison of Facial Growth Between Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients: A Randomized, Prospective, Single-blind Trial.

Nasoalveolar molding (NAM) has become standard treatment in our Craniofacial Center. Two types of pre-surgical NAM, Grayson technique and Figueroa technique, co-exist. We previously found no differences in number of clinic visits, cost and 6 months post-operative outcome between the two techniques. Since Figueroa's method involves passive, whilst Grayson's method involves active, alveolar molding, we extended the previous study to evaluate facial growth between these two groups. This randomized, prospective, single-blind study, conducted between May 2010 and March 2013, recruited 30 patients with unilateral complete cleft lip and palate patients and randomized them for Grayson or Figueroa pre-surgical NAM. Their standard lateral cephalometric measurements at 5 years were used to determine facial growth. Twenty-nine patients completed 5 years of follow-up. There were no statistical differences in facial cephalometric measurements between the two groups. Pre-surgical NAM using either passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair.

Presurgical naso alveolar moulding in a bilateral cleft lip and palate patient- A case report

One third of all craniofacial anamolies of head and neck region are of cleft lip and palate with an incidence of 1 in 700 worldwide. In Asian population the reported incidence is 2.0 per 1000 live births or higher. This case report presents the treatment of a 1-month old bilateral cleft lip and palate baby with Presurgical Nasoalveolar Molding, which was followed by chelioplasty.

Characterizing Interventions and Family Assistance of a Nurse Navigation Program in Orofacial Cleft Care.

Characterize the interventions and assistance employed by a cleft nurse navigator (CNN) which have mediated improvement in care equity at our institution. Retrospective study. Academic tertiary care center. Patients presenting with cleft lip and/or cleft palate presenting between August 2020 and August 2021 with exclusions for syndromic diagnosis, Pierre-Robin sequence, late (> 6 months) presentation, and prior cleft surgery at outside institutions. Multidisciplinary cleft nurse navigator program. Family interactions with the CNN by phone, text, and email across the first year of life including feeding support, nasoalveolar molding (NAM) assistance, appointment scheduling, financial assistance, addressing perioperative concerns, and facilitating physician consults. Patient weight and surgical timing were also recorded. Sixty-nine patients were included with a total of 639 interactions between the CNN and families. Scheduling support (30%), addressing perioperative concerns (22%), and feeding support (20%) were the most common interactions. Feeding support and NAM assistance were heavily distributed in the first 3 months of life compared to after 3 months (P < .001). Median age at first contact was 1 week (range: 22 weeks gestation-14 weeks). There was no difference in the proportion of families receiving feeding support, NAM assistance, or scheduling assistance based on insurance status or race (P > .05 for all). Scheduling assistance, addressing perioperative concerns, and feeding support are the predominant methods by which the CNN interacts with and assists families of patients with cleft conditions. CNN service distribution is largely equitable between demographic groups.

PNAM (Presurgical Nasoalveolar Molding) therapy-first step in preparation of infant for cleft lip and palate repair

PNAM (Presurgical Nasoalveolar Molding) therapy-first step in preparation of infant for cleft lip and palate repair

Initiation to the management of a case of cleft lip and palate in Madagascar: Naso-Alveolar Molding

Introduction: Cleft lip and palate represent the most common facial anomaly in the world, with a prevalence of 4.66‰ in Madagascar in 2016. These malformations constitute aesthetic, functional and social damage. Pre-surgical orthodontic management has not yet been applied in Madagascar. The objective of our study was to report the case of a patient with a cleft lip and palate treated pre-surgically by "Naso-Alveolar Molding". Observation: This is a 3-month-old male child with a bilateral nasolabio-alveolar cleft associated with a total secondary cleft. The initial exo-buccal examination revealed 15mm (left) and 16mm (right) nasal cleft widths, 6mm (left) and 5mm (right) lip cleft widths. The intraoral examination showed 3mm (left) and 4mm (right) of alveolar cleft widths. The treatment consisted of the placement of “Naso-Alveolar Molding”. The evolution having been favorable after a month marked by the reduction of the width of the slits and an aesthetic improvement exo-buccal. Discussion: Pre-surgical orthodontics is performed in infancy to facilitate feeding, reduce cleft width, and reposition deformed nasal cartilages and alveolar processes; to lengthen the deficient columella in the neonatal period. The main objective being to minimize the extent of surgery that would have to be performed. The malleability of the nasal cartilage at the infantile stage indicates the orthodontist to its conception and to ensure a favorable prognosis. Conclusion: The treatment of cleft lip and palate consists of a multidisciplinary approach including Dento-Facial Orthopedics.

Comparison of post-surgical soft tissue changes between bilateral cleft patients treated with and without a modified nasoalveolar molding appliance: A cohort study

The advantages of nasoalveolar molding (NAM) treatment for cleft lip and palate (CLP) patients have been well documented. A modified design for bilateral CLP was introduced. This paper aimed to: 1- quantify the soft tissue changes after applying modified NAM treatment to these patients; and 2-compare post-surgical changes to a control group where no NAM was used. At a tertiary care paediatric hospital, a historical cohort group of complete BCLP patients (n=15) was compared to a prospectively collected group of complete BCLP patients who underwent NAM therapy (n=15). In the NAM group (mean age: 1.1mos±0.2), a new modification of the NAM appliance was implemented. In the control group (mean age: 5mos±0.2), no NAM treatment was adopted prior to lip closure surgery. Soft tissue nasolabial segments were measured on initial (T1), post-NAM (T2) and 3 months post-surgery (T3) photographs; measurements were analysed statistically. In the NAM group, cleft size was reduced by 68 to 70% in 4-5months and all measurements improved between T1 and T2. Columellar crest inclination decreased by 74%, columellar length increased by 184%, nostril and bialar widths decreased by 36% and 16%, respectively. The lip philtrum was elongated by 49.5%. At T3, all soft tissue variables statistically improved better in NAM versus non-NAM groups. The modified NAM appliance provided improved results of lip approximation and nasal measurements compared to non-NAM treatment.

Effect of NAM on Nasal Symmetry and Proportions in Patients with UCLP: A Systematic Review

Introduction : Nasal reconstruction presents a challenge in case of patients with unilateral cleft lip and palate (UCLP). Correction of the nasal deformity to achieve a symmetrical nose from the deficient columella and malformed nasal cartilage in cleft patients presents a great challenge. Nasoalveolar molding (NAM) was developed as a neoadjuvant therapy for patients with cleft lip and palate to improve nasal deformity before surgical intervention. The aim of this systematic review was to understand more about the effect of NAM on nasal symmetry and proportions in patients with UCLP. Method : We searched for manuscripts involving patients with UCLP who received NAM prior to cleft lip repair. Electronic literature searching of the PubMed, Scopus, Cochrane and Google scholar databases was conducted for the studies that had been published up to December 2021. Result : Presurgical NAM demonstrated benefits in nasolabial form when compared with patients who did not receive any presurgical infant orthopaedic appliances (PSIO). The use of presurgical NAM helps to achieve favourable reshaping of the nose and decrease the severity of the initial cleft deformity, resulting in improvement on nasolabial form. These changes lead to improved nasal symmetry and proportions in UCLP patients. Conclusion: The preponderance of evidence in this review suggests that presurgical NAM is a beneficial adjuvant therapy for nasal deformity correction and helps achieve nasal symmetry in patients with UCLP. However, there is insufficient evidence to conclude whether presurgical NAM produces these benefits at the time of nasal maturity.

Parental anxiety/incompliance and patients' complications during COVID-19 pandemic regarding nasoalveolar molding treatment of infants with cleft lip/palate.

The ideal time for nasoalveolar molding (NAM) of infants with cleft lip and/or palate (CLP) is the first weeks after birth. The burden and responsibility that this method of treatment imposes on parents may result in incompliance. The coronavirus (COVID-19) pandemic and the redirection of health resources can make the situation worse. Therefore, this study evaluated the anxiety, complications, and incompliance of parents undergoing NAM during the COVID-19 pandemic. Demographic data of 35 infants with CLP treated during the COVID-19 pandemic, compliance and level of anxiety of both parents in addition to their complications were reported. The association between different variables and incompliance was evaluated by simple and multiple logistic regressions. The level of significance was considered at P value less than 0.05. The highest level of parental anxiety related to the NAM process was the delay in ending the treatment. Meanwhile, the reason for the highest level of anxiety related to attending the treatment sessions was the probability of the infant's COVID-19 infection. Fathers expressed lower levels of anxiety than mothers, significantly. The most prevalent NAM complication was skin irritation. Parents of younger infants (≤28 days) and those with a history of COVID-19 infection were more compliant. COVID-19 pandemic caused a significant increase in the level of anxiety in both parents, mainly due to the delay in treatment ending and the possibility of infant's infection. Moreover, considering the importance of treatment time, parents of younger infants were more compliant with the NAM process.

Nasoalveolar molding: benefits and burdens

Nasoalveolar molding (NAM) has been glorified and maligned. Supporters argue that NAM improves cleft outcomes and reduces secondary procedures. Critics highlight the expense, labor intensity, and inconsistent or transient results. We offer NAM to our patients and have been doing so for over a decade; nevertheless, our benefits assessments are nuanced. In the following paper, we present our rationale, evolution, technique, and outcomes of NAM, augmented with an analysis of the literature. We offer another perspective in this ever-evolving area of evidence-based cleft palate care.

Presurgical Nasoalveolar Molding—Efficacy and Biomechanics in Management of Cleft Lip and Palate: A Review of the Literature

AbstractPresurgical infant orthopaedics (PSIO) appliances are used in the management of cleft lip and palate. Frequently, among all PSIO appliances utilized is presurgical nasoalveolar molding (NAM) appliance. In this review, we looked for the application of the NAM appliance, its efficacy, and biomechanics. A comprehensive search strategy was performed in two databases (Google Scholar and PubMed) for articles using NAM in the treatment plan of patients with cleft lip and palate. Six articles were included in this study with one randomized control trial, two retrospective, and three case reports studies. The studies reveal the NAM is efficient as a presurgical modality treatment for complete cleft lip and palate with multiple benefits, including reducing surgical scars and alveolar gap, used as feeding plate, improve nasal contour, and decreased the number of rectifying surgical procedure.

Nasoalveolar Molding for Unilateral Cleft Lip and Palate with 4 Years Follow Up: A Case Report

Background: Primary surgical repair of the lip and nose usually results in wide scar and reduced nasal esthetic. Presurgical nasoalveolar molding (NAM) aim to reduce the severity of the initial cleft deformity, thereby enabling the surgeon to perform better outcomes. The aim of this case report is to document the long-term (4-year) outcome of NAM and surgical repair of the unilateral cleft lip and palate. Case presentation: Two days old female neonate with unilateral cleft lip and palate was presented with initial intersegment distance of 8mm. Molding plate was inserted and modified weekly to guide the alveolar cleft segments to the desired position. The nasal stent was attached to the appliance on the 16th day after reducing the cleft gap to 5mm and it was adjusted weekly to mold the nasoalveolar complex into the desired shape. At 3 months of age, the intersegment distance was 3mm and the patient underwent primary surgical repair of the lip and nose. At age of 9 months, a palatal repair was performed. Result: At the last patient&amp;apos;s follow up visit (at age of 4 years), there were minimal scars on the lips and nose, and all primary teeth had erupted except the upper left lateral incisor. Conclusion: Nasoalveolar molding is effective in reducing the width of the cleft and improving the nasal architecture.

A novel modification of nasoalveolar molding procedure to enhance ease of use

Cleft lip and palate (CLP) is one of the most common craniofacial birth defects. Its incidence varies according to race, sex and region. As ubiquitous as the condition may be, when it comes to clinical presentation, CLP manifests in a myriad of forms and varieties. The most common clinical presentation is that of a unilateral cleft lip and palate (UCLP). Management of CLP is a challenging proposition but in recent times, the results have become better owing to standardization of treatment protocol and the availability of multidisciplinary teams at specialized cleft centers worldwide. Management of CLP is initiated right from birth with parental counselling followed by presurgical infant orthopedics (PSIO). Nasoalveolar moulding (NAM) is on of the most widely accepted modalities of PSIO and is used to achieve alignment of the cleft alveolar segments into a more ideal relationship prior to the primary lip repair surgery. In its bare essence, NAM uses an acrylic molding plate with selective addition and removal of soft liner to mould the segments into a more ideal position. The molding plate is held in place with elastics which are retained by the use of adherent tapes on the cheek. The use of these tapes on a young infant often leads to tissue irritation and results in reduced compliance and treatment effect. Herein this case report we aim to highlight a novel approach of retaining the molding plate which dispenses with the need of adherent tapes. This technique has the benefit of no tissue irritation, easier application and improved compliance.

Knowledge, Attitude, and Perception among Dental Graduate Practitioners about Presurgical Naso-alveolar Molding Therapy in cleft lip/palate infants: A Questionnaire-based Survey

Aim: To explore or evaluate dentist’s (BDS graduate practitioners) knowledge and perception towards Presurgical Naso-alveolar molding (PNAM) in cleft lip/palate infants. Materials and methods: A questionnaire containing 10 validated questions (Google forms) was electronically distributed through E-mail and WhatsApp. A total of 144 BDS graduate practitioners were included in the study. The data obtained was subjected to statistical analysis. Results: The majority of BDS practitioners were not aware of PSNAM regarding many of its aspects like the time duration required for PSNAM treatment, the person who performs PSNAM, the design of the appliance, and the infant's age at which it is carried out. 91% of the practitioners showed interest in learning information about PSNAM and wished to attend workshops or courses about PSNAM. Conclusion: There is a necessity to enhance the level of awareness, perception, and knowledge of BDS graduate practitioners towards the PNAM treatment performed in cleft lip/palate infants.

Defining the Treatment Gap in Nasoalveolar Molding: Factors Affecting the Utilization of NAM in an Urban Cleft Center.

Many cleft centers incorporate NasoAlveolar Molding (NAM) into their presurgical treatment protocols. However, there are limited data on eligible patients who do not receive or complete NAM. This study characterizes the demographics associated with non-utilization or completion of NAM. A single-institution retrospective review was performed of all patients with cleft lip and alveolus undergoing primary unilateral and bilateral cleft lip repair from 2012-2020. Patients were grouped based on utilization or non-utilization of NAM. Demographic and treatment data were collected, including documented reasons for not pursuing or completing NAM. Of 230 eligible patients, 61 patients (27%) did not undergo or complete NAM (no-NAM). In this group, 37 (60.7%) received no presurgical intervention, 12 (19.7%) received presurgical nostril retainers, 3 (4.9%) received lip taping, 1 (1.6%) received a combination of taping/nostril retainers, and 8 (13.1%) discontinued NAM. The most common reasons for not receiving NAM were sufficiently aligned cleft alveolus (21.3%), medical complexity (16.4%), late presentation (16.4%), and alveolar notching (18%). Compared to the NAM group, the no-NAM group had significantly lower rates of prenatal cleft diagnosis/consult, and significantly higher proportion of non-married and non-English speaking caregivers. Multivariable analysis controlling for insurance type, primary language, prenatal consult, marital status, and age at first appointment found that age at first appointment is the only statistically significant predictor of NAM utilization (P < .001). Common reasons for non-utilization of NAM include well-aligned cleft alveolus, medical complexity, and late presentation. Early presentation is an important modifiable factor affecting rates of NAM utilization.