In addition to recommending surgery to close a cleft lip and/or palate, your child’s cleft team may recommend a form of treatment called pre-surgical infant orthopedics (PSIO). PSIO treatment is usually overseen by the orthodontist or pediatric dentist on the cleft team. Its purpose is to reduce the size of a cleft lip during the weeks and months before a baby’s lip-repair surgery.

There are three main forms of pre-surgical infant orthopedics: NAM treatment, Latham treatment, and lip taping.

NAM Treatment

With nasoalveolar molding (NAM), a custom-made plate is placed in an infant’s mouth and held in place with tapes that attach to the child’s cheeks. The plate and the tape mold the tissue around the cleft to change the shape of the lips and gums. Some babies wear nasal stents as well, to reshape the nostrils.

NAM treatment requires daily home care and regular adjustments (usually weekly) by the orthodontist or dentist on the cleft team.

Latham Treatment

With Latham treatment, an appliance is placed in the baby’s mouth surgically (rather than taped) and is tightened in the office and at home. Latham treatment reduces the space of a baby’s cleft and reshapes the dental arch; it does not alter the shape of the nose.

Face Taping

With face taping, adhesive tapes are placed on the baby’s face to reduce the space of a cleft lip. Lip taping regimens vary from team to team. In some cases, a team will suggest combining face taping with other forms of therapies to reshape the nostrils, such as a nasal elevator or a nasal stent (called NoseAlign®). Face taping does not involve a plate or appliance worn inside the mouth.

Face taping is considered simple and convenient for caregivers; its effectiveness is not well studied in medical literature.

Citations:

American Cleft Palate Craniofacial Association. Preparing for Surgery. ACPAcares.org. Accessed September 1, 2024. https://acpacares.org/resource-center/.

R V, Singhal R, Namdev R, Kumar A, Dayma C, Rani A. Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis. The Cleft Palate Craniofacial Journal. 2024;0(0). doi:10.1177/10556656241249822

Shetye PR. An Innovative Technique of Presurgical Lip, Alveolus, and Nose Approximation (PLANA) for Infants with Clefts. J Craniofac Surg. 2024;35(4):e357-e359. doi:10.1097/SCS.0000000000010107

Page reviewed by Soumya Padala, BDS, MDS; ACPA Family Resources Committee