Inside Pediatrics Summer 2022

ONE LITTLE DEVICE WITH MAJOR RESULTS N ot even a year old, Crew Mitchell is already full of personality and smiles, his mom Jessica says. His smile is extra sweet because Crew was among Children’s of Alabama’s first patients to complete a pre-surgical cleft lip and palate therapy called nasoalveolar molding, or NAM.

babies are referred to Children’s of Alabama annually for cleft lip surgery, and those with large or wide cleft lips are typically good candidates for NAM therapy. During Crew’s initial appointment, the family met with orthodontist Dr. Chung Kau and plastic surgeon Dr. John Grant along with speech therapists,

Jessica found out during her 20-week ultrasound that Crew had cleft lip—a condition caused when the upper lip and the roof of the mouth, called the palate, fail to form completely during early fetal development. This causes a gap, called a cleft, in the palate and on one or both sides of the upper lip. In some cases, a child may have cleft lip or cleft palate; in other cases, the child may have both. When Crew was born in August 2021, he had a bilateral cleft lip—a cleft on both sides of his upper lip—and a cleft palate. A week after Crew’s birth, doctors referred the family to the Cleft & Craniofacial Center at Children’s of Alabama, one of the first hospitals in the state to offer NAM. The goal of NAM is to reduce the size of the cleft by molding and repositioning the nose and mouth tissues before surgery. Babies wear a custom-fitted appliance similar to a retainer up to 23 hours a day for about 12 weeks. The therapy can help improve the shape and position of the lip and nose, create a smaller cleft to make surgery easier and quicker, and reduce the number of surgeries needed to repair the lip and palate. It also makes it easier for the child to feed and breathe. Approximately 50

audiologists and geneticists. Dr. Kau had dental impressions made of Crew’s mouth that day for his custom appliance. The family returned to Children’s weekly from their Elmore County home so Dr. Kau could adjust the appliance to better position the gums, nose and lips as Crew grew. “Dr. Kau was so good to Crew,” Jessica said. “He was very

Chung Kau, M.D.

kind and quick to respond to my questions. The follow-up appointments were never long—they took just enough time to make adjustments as needed. We are fortunate to live so close to a hospital that offers NAM. Some families (in a Facebook group for parents of babies with a cleft lip) said they would have to drive five hours or more to get to the nearest facility for their child to have NAM.”

mold to make PNAM device

NAM device

NAM week 1

NAM week 3

Birth

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