Science Journal of Clinical Medicine 2016; 5(4-1): 1-6 http://www.sciencepublishinggroup.com/j/sjcm doi: 10.11648/j.sjcm.s.2016050401.11 ISSN: 2327-2724 (Print); ISSN: 2327-2732 (Online) Case Report A Stepwise Procedure for the Fabrication of the NAM Appliance Using Grayson’s Technique Rohit Raghavan 1 , Biswas PP 2 , Shaju George 3 , Shiji M. Kunjappan 4 1 Dept of Prosthodontics, Royal Dental College, Palakkad Dst, Kerala 2 Dept of Orthodontics, Royal Dental College, Palakkad Dst, Kerala 3 Dept of Oral and Maxillofacial Surgery, Royal Dental College, Palakkad Dst, Kerala 4 Department of Orthodontics, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India Email address: drrovan@gmail.com (R. Raghavan), biswas_pp@yahoo.com (Biswas PP), chackochammanam@gmail.com (S. George), doctorsk01@gmail.com (S. M. Kunjappan) To cite this article: Rohit Raghavan, Biswas PP, Shaju George, Shiji M. Kunjappan. A Stepwise Procedure for the Fabrication of the NAM Appliance Using Grayson’s Technique. Science Journal of Clinical Medicine. Special Issue: Clinical Conspectus on Cleft Deformities. Vol. 5, No. 4-1, 2016, pp. 1-6. doi: 10.11648/j.sjcm.s.2016050401.11 Received: December 23, 2015; Accepted: February 24, 2016; Published: March 23, 2016 Abstract: Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have obtained aesthetic results. Nasoalveolar molding (NAM) has gained wide acceptance and evidence in cleft therapy. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients. The principle objective of presurgical nasoalveolar molding (NAM) is to reduce the severity of the initial cleft deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of cleft deformity that is of minimal severity. For the fabrication of such appliances, an impression of the defect is necessary. Impression making in infants with cleft lip and palate is a challenging task. Keywords: Cleft Lip and Palate, Impression Procedure, Infantile Orthopaedics, Nasoalveolar Molding 1. Introduction Nam is orthopedics done in CLCP to move and align the separate maxillary segments, approximating the lip segments and repositioning and uprighting the septal cartilage. Eversince its introduction by Mc Niel in 1954, many authors have used various techniques to move the maxillary segments, from simple non invasive acrlylic plates to complex invasive pin retained appliances. Authors like Barry Greyson, Latham, Court Cutting, etc. have pioneered the research in this field. [1] NAM or infantile orthopedics (IO) is a procedure which has to be ideally initiated as early as 0 to 3 months of age as it is at this age that the primary cartilage is moldable. As age advances beyond 2 months, the level of chondroitin sulphate rich proteoglycan which is responsible for increase mouldability of the growing cartilage is considerably decreased and IO becomes difficult. [2] In unilateral cleft patients the two alveolar segments are mal aligned with the smaller cleft segment being collapsed palatally. This causes the mal alignment of the maxillary segments with gross asymmetry. Similarly, the septal cartilage is pulled towards the non cleft side causing the ala on the cleft side to be flattened and stretched. This causes an asymmetry of the nasal apertures and also decreases the nasal projection. In addition, the two lip segments stand well away from each other and any surgical intervention without NAM would cause tremendous amount of stretch on the sutured lips thus applying undue pressure on the alveolar segments. This concomitantly affects the anterior – posterior growth of the maxilla in the future. [3] NAM aims at aligning the maxillary alveolar segments, uprightinging the nasal septum, reforming the curvature of the alar cartilage and approximating the lip segments. Apart from facilitating better surgical conditions, NAM provides unrestricted maxillary growth. [4]