What is PNAM?

PNAM is an acronym for Presurgical NasoAlveolar Molding Appliance. It is an appliance—something like the retainers that orthodontists use to move or maintain the position of teeth—that gently begins to move the soft and hard tissue of the cleft lip and palate toward closure before the primary closure surgery.

What is cleft lip and cleft palate?

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Together, these birth defects commonly are called “orofacial clefts.”

See: https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

Are all cleft patients candidates for PNAM treatment?

No. If there is no lip cleft, or the cleft is only in the soft palate or in the middle of the palate, there is no need for PNAM. Please consult with a pediatric dentist who has previously used PNAM appliances to treat cleft lip and cleft palate patients.

When should PNAM treatment be started?

Treatment is usually started when the baby is between 6 and 8 weeks old. At this time the baby’s neck has matured sufficiently, and it is safe to start treatment. If the patient has muscle deficiency, and the neck cannot be supported, the dentist or physician may decide to delay treatment.

What are the common dental problems for cleft lip and cleft palate patients?

Cavities, crowding, crooked teeth, extra teeth, missing teeth, an opening on the roof of the mouth (fistula), misshapen teeth, and discolored teeth.

Can cleft lip and cleft palate be fixed?

Yes! With the help of a craniofacial team, normal function and improved appearance can be achieved. It is important to begin treatment at the earliest opportunity.

How early can you detect cleft lip and cleft palate?

Cleft lip or cleft palate can be detected by ultrasound between the 13th and 16th week of pregnancy

Will braces be needed when the patient is older?

Yes. Most cleft lip and cleft palate patients need orthodontic (braces) treatment.

Will speech be affected after treatment?

Depending on the severity of the cleft, patients may need an artificial mouthpiece (obturator) or extra surgeries and speech therapy to improve their speech. Patients should see a speech pathologist for an evaluation.

Do cleft lip and cleft palate patients score lower on intelligence tests?

No. Cleft lip and cleft palate patients have the same intelligence distribution as the population in general.