Jason Paternoster is one tough toddler. Mom Tiffany is thankful his only visible facial scar resulted from a recent tumble.
You'd never guess this three-year old was born with a severe cleft lip and palate. Doctors spotted the cleft during Tiffany's routine, prenatal ultrasound. Three days after he was born, Jason began a unique treatment called nasoalveolar molding, or NAM.
"Babies are very moldable after birth because of the increased level of maternal estrogen," says Lisa Vecchione, D.M.D., M.D.S., a craniofacial orthodontist at Children's Hospital of Pittsburgh of Univeristy of Pittsburgh Medical Center.
With NAM, orthodontists take a dental impression of a newborn's mouth in order to create a mold, similar to a small denture. The baby wears it around the clock, guiding the mouth and lip into place.
"I make small adjustments where I add denture liner to push the gum ridge in the position I want it to be in, and I relieve areas of the denture where I want the tissue to grow into," Dr. Vecchione says.
Doctors examined Jason weekly, adding nasal stents to help shape his face. After five months, plastic surgeons repaired the cleft nose and lip.
"It really sets the stage to make surgery much easier," says Joseph Losee, M.D., Chief of Pediatric Plastic Surgery at Children's Hospital of Pittsburgh of Univerisy of Pittsburgh Medical Center.
These days, Jason has a smile that lights up a room. Tiffany credits the surgical team and nasoalveolar molding.
"It's the most wonderful thing we could have been introduced to for Jason," Tiffany says.
There are a wide variety of techniques currently used before cleft surgery, including lip taping and a mouthpiece that is attached to the mouth with screws. Surgeons say NAM is painless, but it can be time-consuming for the family since it requires a weekly doctor's visit to adjust the appliance.
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