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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Orthodontics · Cleft lip

What Is Nasoalveolar Molding for Cleft Lip? Timing and Care

At a Glance

Nasoalveolar molding (NAM) is a custom appliance used before surgery for some babies whose cleft lip also involves the gum ridge and often the palate. It gradually brings the tissues closer together, but requires daily care and does not replace surgery.

In this answer

4 sections

01

What is Nasoalveolar Molding (NAM)?

02

How Does NAM Work?

03

The Commitment: What It Means for Parents

04

Does Every Baby Need NAM?

Nasoalveolar Molding (NAM) is a custom-made orthodontic appliance similar to a retainer that gently brings a baby’s gum, lip, and nose tissues closer together over several months before primary cleft lip surgery [1][2]. By reducing the gap between the cleft segments, NAM aims to make the initial cleft repair surgery easier [1][3].

What is Nasoalveolar Molding (NAM)?

NAM is a presurgical orthodontic treatment designed for babies born with a cleft lip that also involves the gum ridge (alveolus) and often the palate. It is not typically needed for an isolated cleft lip. NAM uses a custom-made oral plate with attached nasal stents to gradually shape and reposition the gum segments, lips, and the soft tissue of the nose (nasal cartilage) [1][2][4].

It is important to understand that NAM is a preparatory step: it shapes the tissues before surgery, but it does not close the palate or replace the need for lip, palate, or future surgeries.

How Does NAM Work?

The NAM appliance consists of a custom-fitted oral plate (which looks like a small denture or retainer) with small wire stents that extend up into the baby’s nostrils. Over a period of months, the plate helps guide the gums together, while the nasal stents lift and shape the nose [1][2].

Treatment usually begins within the first few weeks of life, when the baby’s cartilage is still soft, and continues until the primary lip repair surgery (often at a few months of age) [5][6]. The exact schedule depends on your cleft team. While near-continuous wear is common, you must follow your team’s specific protocol for whether to remove the plate during feeding and cleaning [7].

The Commitment: What It Means for Parents

While NAM can help prepare the tissues for surgery, it requires a heavy time and emotional commitment from parents [8][7]. The treatment is demanding for several reasons:

  • Frequent Adjustments: The baby will typically need to see the cleft team every 1 to 2 weeks so the plate and stents can be gradually adjusted [7][9].
  • Daily Care and Cleaning: Parents must clean and reinsert the device daily, which can be stressful [8][7]. Always follow your team’s written instructions, and never try to adjust the appliance yourself.
  • Taping: Specialized tape holds the appliance to the baby’s cheeks. Parents must learn proper taping techniques to protect their baby’s delicate skin.
  • Safety Checks: You will need to monitor your baby for skin irritation, mouth sores, bleeding, or feeding difficulties, and contact your team if the appliance fits poorly or comes loose.

Does Every Baby Need NAM?

No, not every baby with a cleft lip requires NAM before surgery. The decision depends on the width of the cleft gap, the type of cleft, the baby’s overall health, and the local cleft team’s expertise [10][9][11]. Your family’s capacity to manage the travel, cost, and daily workload is also a valid and important factor.

For babies with very wide clefts, NAM can significantly reduce the gap before surgery [12]. A narrower cleft may make the surgical repair easier, though evidence that NAM prevents postoperative complications like an oronasal fistula (a hole between the mouth and nose that didn’t heal completely) is limited and varies across studies [3][13].

Research on the long-term benefits of NAM is still evolving. While it successfully reduces the cleft gap in the short term [12], evidence that it permanently improves how the face looks as the child grows (facial aesthetics) is mixed and often considered low-certainty [14][15].

Because of the heavy family burden, some cleft teams may recommend alternatives to NAM, such as passive molding, lip taping alone, or proceeding directly to surgery [8][16]. These alternatives have different goals—for instance, lip taping does not shape the gums and nose the way NAM does—but they can be the right choice depending on your baby’s anatomy and your family’s situation. Choosing an alternative supported by your team does not mean you are doing less for your baby. It is important to discuss all options with your multidisciplinary cleft team to decide the best approach for your family.

Common questions in this guide

What does NAM do for a baby with cleft lip?
Nasoalveolar molding (NAM) is a custom oral plate with small nasal stents. Worn before surgery, it gradually guides the gum, lip, and nose tissues closer together; it prepares the tissues but does not close the palate or replace cleft lip or palate surgery.
Is NAM necessary for every baby with a cleft lip?
No. NAM is more often considered when the cleft also involves the gum ridge and often the palate, especially when the gap is wide, but the decision also depends on the baby's health, the cleft team's experience, and what your family can manage. Your multidisciplinary cleft team should discuss NAM and alternatives with you.
When does NAM start, and how long does treatment last?
Treatment often starts within the first few weeks of life, when the baby's cartilage is soft, and continues for several months until primary cleft lip repair. Babies commonly wear the appliance nearly continuously, but your cleft team should tell you whether to remove it for feeding and cleaning.
What do parents have to do each day during NAM?
Parents usually clean and reinsert the appliance, apply or replace the cheek tape, and check the baby's mouth and skin each day. Clinic visits are often needed every one to two weeks for adjustments, and parents should never adjust the plate or stents themselves.
What problems with a NAM appliance should I report?
Call your cleft team if your baby develops skin irritation, mouth sores, bleeding, feeding difficulty, or a device that fits poorly or comes loose. Follow the written after-hours plan because the team can decide whether the appliance needs to be checked or changed.
Can NAM improve the results of cleft lip surgery?
NAM can narrow the cleft gap before surgery, which may make the first repair easier, especially when the gap is wide. Research is still uncertain about whether NAM prevents a hole between the mouth and nose after surgery or produces lasting changes in facial appearance.
What can we do instead of NAM?
Depending on the baby's anatomy and your family's circumstances, a cleft team may discuss passive molding, lip taping alone, or going directly to surgery. These options have different goals and daily demands, so choosing one with your team does not mean you are doing less for your baby.

Questions For You

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Related questions

Will My Child Need Jaw Surgery or a Cleft Nose Job? What Happens During Alveolar Bone Grafting for Cleft Palate? Can a Cleft Palate Be Seen on a Prenatal Ultrasound? Can You Breastfeed a Baby With Cleft Lip or Palate? Does Insurance Cover Cleft Lip and Palate Surgery?
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What Is the Risk of a Second Baby with Cleft Lip or Palate? What Causes Hypernasal Speech After Cleft Palate Repair? What Is Pierre Robin Sequence (PRS)? Cleft Palate in Babies What Is the Rule of Tens for Cleft Lip Surgery Timing? Why Do Babies With a Cleft Palate Get Ear Infections?

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given the width and type of my baby's cleft, do you recommend NAM, and what specific benefits would it provide for their primary lip repair surgery?
  2. 2.What is your team's exact protocol for NAM, including the daily cleaning routine, feeding instructions, and frequency of clinic visits?
  3. 3.What signs of irritation, poor fit, or feeding issues should prompt us to call the clinic, and who do we contact after hours?
  4. 4.If we decide not to proceed with NAM, what are the alternative presurgical options like lip taping, and how do they differ in daily workload and surgical goals?
  5. 5.Can you connect us with another family who has recently completed NAM treatment with your clinic to hear about their experience?

References

References (16)
  1. 1

    Controversies in the Management of Patients with Cleft Lip and Palate.

    Rodman RE, Tatum S

    Facial plastic surgery clinics of North America 2016; (24(3)):255-64.

    PMID: 27400840
  2. 2

    Presurgical cleft lip and palate orthopedics: an overview.

    Alzain I, Batwa W, Cash A, Murshid ZA

    Clinical, cosmetic and investigational dentistry 2017; (9()):53-59 doi:10.2147/CCIDE.S129598.

    PMID: 28615974
  3. 3

    Assessment of Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Cleft Lip and Palate and Its Postsurgical Stability.

    Bhutiani N, Tripathi T, Verma M, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2020; (57(6)):700-706 doi:10.1177/1055665620906293.

    PMID: 32116001
  4. 4

    Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate Improves Nasal Symmetry and Maxillary Alveolar Dimensions.

    Ruíz-Escolano MG, Martínez-Plaza A, Fernández-Valadés R, et al.

    The Journal of craniofacial surgery 2016; (27(8)):1978-1982 doi:10.1097/SCS.0000000000003047.

    PMID: 28005737
  5. 5

    Stress Distribution Patterns within Viscero- and Neurocranium during Nasoalveolar Molding: a Finite Element Analysis.

    Ritschl LM, Heinrich V, Grill FD, et al.

    Plastic and reconstructive surgery. Global open 2018; (6(7)):e1832 doi:10.1097/GOX.0000000000001832.

    PMID: 30175012
  6. 6

    Early Cleft Lip Repair: Demonstrating Efficacy in the First 100 Patients.

    Wlodarczyk JR, Wolfswinkel EM, Liu A, et al.

    Plastic and reconstructive surgery 2022; (150(5)):1073-1080 doi:10.1097/PRS.0000000000009634.

    PMID: 35998144
  7. 7

    Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial.

    Kalaskar R, Bhaje P, Sharma P, et al.

    Journal of the Korean Association of Oral and Maxillofacial Surgeons 2021; (47(4)):257-268 doi:10.5125/jkaoms.2021.47.4.257.

    PMID: 34462383
  8. 8

    Presurgical Orthopedic Intervention Prior to Cleft Lip and Palate Repair: Nasoalveolar Molding Versus Passive Molding Appliance Therapy.

    Gibson E, Pfeifauf KD, Skolnick GB, et al.

    The Journal of craniofacial surgery 2021; (32(2)):486-491 doi:10.1097/SCS.0000000000006929.

    PMID: 33704966
  9. 9

    A Comparison of a Novel Passive Nasoalveolar Molding Technique Versus Traditional Active Molding for Alveolar Cleft Reduction.

    Qureshi UA, Hallman T, Rai P, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2026; 10556656261466058 doi:10.1177/10556656261466058.

    PMID: 42405640
  10. 10

    A Comparative Assessment of Nasal Appearance following Nasoalveolar Molding and Primary Surgical Repair for Treatment of Unilateral Cleft Lip and Palate.

    Kurnik NM, Calis M, Sobol DL, et al.

    Plastic and reconstructive surgery 2021; (148(5)):1075-1084 doi:10.1097/PRS.0000000000008462.

    PMID: 34546190
  11. 11

    A Comprehensive Clinical Perspective of Nasoalveolar Molding (NAM) for the Treatment of Cleft Lip and Palate patients.

    Ali AAA

    Journal of clinical and experimental dentistry 2025; (17(5)):e552-e559 doi:10.4317/jced.62575.

    PMID: 40485962
  12. 12

    Effectiveness of nasoalveolar molding treatment for babies with nonsyndromic complete unilateral cleft lip, alveolus, and palate: A systematic review and meta-analysis.

    Thiruvenkatachari B, Chakkaravarthi S, Bhuvaraghan A

    American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2025; (168(1)):2-13.e4 doi:10.1016/j.ajodo.2025.01.012.

    PMID: 40117424
  13. 13

    The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty.

    Siriwiroj S, Pisek P, Punyavong P, et al.

    The Journal of craniofacial surgery 2024; (35(2)):412-414 doi:10.1097/SCS.0000000000009872.

    PMID: 37983067
  14. 14

    Nasal Symmetry Outcomes After Nasoalveolar Molding (NAM) Plus Cheiloplasty Treatment in Babies With Cleft Lip/Palate: Systematic Review and Meta-Analysis.

    Souza TM, de Abreu Refaxo N, Macari S, Abreu LG

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2026; (63(6)):1688-1700 doi:10.1177/10556656251346368.

    PMID: 40491193
  15. 15

    The Impact of Presurgical Nasoalveolar Molding on Midface Growth in Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

    Moshal T, Roohani I, Jolibois M, et al.

    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association 2025; (62(11)):1939-1946 doi:10.1177/10556656241286386.

    PMID: 39668661
  16. 16

    Cleft Lip Repair, Nasoalveolar Molding, and Primary Cleft Rhinoplasty.

    Bhuskute AA, Tollefson TT

    Facial plastic surgery clinics of North America 2016; (24(4)):453-466 doi:10.1016/j.fsc.2016.06.015.

    PMID: 27712813

This page explains NAM and presurgical care for educational purposes; it is not medical advice. Your baby's cleft team should recommend the approach and provide instructions for fitting, feeding, cleaning, and when to call.