Pediatric otolaryngologists Larry Hartzell, M.D., and Adam Johnson, M.D., Ph.D., are partnering with pediatric craniofacial orthodontists for a pre-surgical orthopaedic process that can prepare their pediatric cleft lip and palate patients for better surgical results and potential reduction in surgery requirements.
The procedure is called nasoalveolar molding (NAM). Hartzell, an associate professor in the UAMS Department of Otolaryngology — Head and Neck Surgery and director of the department’s cleft lip and palate team that operates at Arkansas Children’s Hospital, has been offering the procedure at Children’s for over a year.
Infants who are good candidates for NAM undergo a two- to four-month process managed by the craniofacial orthodontist. The infant is fitted with a retainer-like device that is adjusted on a weekly basis. The procedure can improve the position of the gums, lips and nasal structures for the primary cleft surgery.
“The first advantage to the NAM procedure is the change to the anatomic relationships,” Hartzell said. “Many of these patients go on to have better cosmetic outcomes than with traditional techniques, with better scarring and nasal position. Two, we find it improves their overall hygiene and gumline positioning. And maybe most importantly, it can reduce the number of future surgeries required as part of their cleft treatment.”
NAM is especially useful for patients with big or wide clefts, which previously required many separate surgeries: one to two to repair the lips, two or more to shape the nose, another to close the palate and another later for a bone graft, and then possibly others. Instead, physicians take advantage of the malleability of the gums, lips and nostrils in early infancy to move them to optimal positions for surgery and, in some cases, make it possible to do multiple surgeries in one single setting.
After the molding process is complete, patients may need as few as one surgery from Hartzell or Johnson to bring the lip together, finish shaping the nose and repair the gumline.
“Each patient is unique, so we work closely together with the orthodontists throughout the process,” Hartzell said. “It’s a collaboration that is paying off greatly for our patients, and our team will continue to look for opportunities to make these kinds of innovative approaches available to our patients.”
To make an appointment, call 501-364-4000.