Orthodontic Devices

Presurgical orthodontics

We offer presurgical orthodontics as part of a comprehensive plan for your child. After we meet your baby, we will examine them to determine if any devices are needed. We offer 3 different options discussed below. Our Orthodontist and team will discuss each option with you and which one we recommend for your child.

Presurgical orthodontics is a nonsurgical method used to reshape the gums, lip and nostrils with a small removable appliance. The plastic appliance is used before cleft lip and palate surgery for your child to help decrease the number of surgeries needed and to reduce the severity of the cleft condition. It can help children with large or wide clefts and has greatly advanced cleft repair. 

Benefits of Presurgical orthodontics

• Improvement of the shape and position of the lip and nose
• Smaller alveolar cleft
• Easier repair of cleft lip and palate

Not all patients are candidates for presurgical orthodontics, and some children may not tolerate the devices. Our surgeons have trained to repair clefts without these devices and have had successful outcomes for those patients.

Presurgical Options at Children’s of Alabama

• Lip Taping
• PLANA
• NAM

Process of Lip Taping

                  If your child has an isolated cleft lip, we may consider using lip taping to help narrow the gap. After discussion of options, we will show you how to apply the tape. We recommend keeping the tape on for 23 hours a day and replacing daily as tape stretches with saliva and milk. We will plan to see you about monthly in clinic to follow your child’s progress. Here is a video link to see how to apply lip tape.

 

Process of PLANA

                  If your child has a cleft that impacts the nose, we may consider using PLANA to help narrow the lip gap and improve the shape and appearance of the nose. There are 3 nose align devices, 1, 2, & 3. After discussion and decision to start PLANA, the first step is lip taping. We will then have you return to clinic in 1 week to start Nose align 1.  We recommend this to be left in place for 23 hours, 7 days a week. NA 1 will be used for about 1 month before progressing to NA 2 which will be used for 1 month and then NA 3 again to be used for about 1 month. After completion of the 3 devices, your child will proceed to surgery for cleft lip. PLANA can also help to move the gum and alveolus which can make surgical correction of the palate easier as well. 

 

Process of NAM 

There are many benefits to this type of pre-surgical cleft lip and palate therapy. 

• It improves the shape and position of the lip and nose. The gums and bone are molded into a better position by reducing the cleft inside the mouth, the gap in the upper lip, and lifting and narrowing the nose to create a smaller cleft to make surgery easier and quicker.
• The removable appliance becomes something like a pacifier, meaning children tend to adapt well to the treatment.

NAM works to gently direct the growth of your baby’s gums and the shape of their nose during the first few months after birth, when these tissues are soft and easy to mold.

• Following the consultation and custom medical plan, we will perform an initial scan of your newborn baby with digital or traditional equipment depending on your child’s specific needs. We will need to do this as soon as possible, ideally before one week of age. Your baby's NAM appliance then will be ready about one week later after the scan.
• Parents work directly with a Children’s orthodontist during NAM therapy. The orthodontist fits your baby with a custom molding plate that looks like a retainer someone would receive after braces.
• Your baby wears the molding plate 22-24 hours a day, 7 days a week, including when they are feeding. The plate is held in place using small rubber bands that are taped to your baby’s cheeks. Our NAM team will teach you how to change the rubber bands and the tape and clean the molding plate at home as needed (usually each day).
• Every 1 to 2 weeks for an estimated 12 weeks, the orthodontist makes small changes to the shape of the molding plate to guide the baby’s gums as they grow. Each visit takes 40 to 60 minutes. Families will have regular visits over an estimated 12 weeks
• Once the gap in the gums is small enough, the orthodontist adds a post covered called a nasal stent with smooth, rounded plastic to the front of the molding plate. The nasal stent slides easily into the baby’s nostril. It slowly lifts up the nose and shapes the nostril on the side of the cleft.
• After the NAM method is complete, your child will have surgery to pull their lip together and to further shape their nose, and your baby will no longer need the NAM appliance.

How does NAM feel for my baby?
The molding plate and nasal stent are not painful. NAM does not push or stretch the delicate tissues; it only helps gently direct their growth. 

After getting used to the plate for a few days, some babies seem happier wearing it than they do without it. This may happen because the plate acts as a palate or the roof of the mouth. It keeps your baby’s tongue from pushing into the cleft, and it makes feeding easier for your baby.