Pediatric and Craniofacial Surgery

Pediatric and Craniofacial Surgery

Our Center offers the full range of pediatric plastic surgery, and our Pediatric Plastic surgeons have great experience in helping families with children who may present with cleft lip and/or cleft palate, craniosynostosis, deformational plagiocephaly, vascular malformations, and other pediatric plastic surgery issues. Our Pediatric plastic surgeons provide the finest surgical care from routine birthmark removal to the most complex congenital or facial deformities while using leading-edge techniques and technologies.

Team approach

We do more than correct conditions that affect function and appearance. Our compassionate experts understand that many of these disorders and injuries affect a child’s self-esteem and confidence. That’s why we offer support to kids and their families. Working as a team with your family, we tend to your child’s emotional health, physical function, speech and communication, and other areas. Your child’s care team may include doctors who specialize in eye care, skin, dentistry, orthopedics and other areas — to ensure all your child’s needs are met.

Our Craniofacial team is highly specialized and dedicated to early diagnosis and treatment of craniofacial conditions with a team approach.

The team members include specialists in the following:

  • pediatric plastic and reconstructive surgery
  • pediatric neurosurgery
  • orthodontics
  • oral surgery
  • otolaryngology
  • prosthodontics
  • dermatology
  • speech pathology
  • genetics
  • nursing
Comprehensive Pediatric Plastic Surgery Care

We provide children and teens reconstructive or corrective surgery to improve the appearance and/or formation of children with cleft lip and palate, as well as trauma and burns, scars, lesions of the skin and more complex structural abnormalities of the head and face, such as:

  • Benign and malignant neoplasms of the scalp and skin
  • Craniofacial syndromes
  • Craniofacial deformities, such as cleft lip or palate or disfigurement of the head, neck, mouth, jaw, and ears
  • Vascular anomalies, such as birthmarks
  • Congenital hand and foot malformations
  • Cosmetic concerns, including breast, nose and jaw reconstruction
  • Birthmarks
  • Cleft lip and/or cleft palate
  • Cranial abnormalities
  • Craniosynostosis
  • Cystic Hygroma
  • Dog bite
  • Ear deformities\
  • Facial deformities
  • Gynecomastia
  • Hypertrophic scar or atrophic scar
  • Microtia
  • Nasal or Deviated Septum Deformity
  • Polydactyl fingers and or toes
  • Post-traumatic deformities
  • Traumatic injuries
  • Alveolar Cleft
  • Submucous Cleft Palate
  • Blepharoptosis
  • Scaphocephaly
  • Trigonocephaly
  • Plagiocephaly
  • Hypertelorism
  • Orbital Dystopia

Cleft Lip or Palate

In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about one of every 800 babies, those sections don’t quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.

If your child was born with either or both of these conditions, your doctor will probably recommend surgery to repair it. Medical professionals have made great advances in treating children with clefts and can do a lot to help your child lead a normal, healthy, happy life.

This information will give you a basic understanding of the operation — when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on you individual circumstances. Please be sure to ask your surgeon if there is anything you don’t understand about the procedure.

Children born with a cleft lip or palate may need the skills of several medical professionals to correct the problems associated with the cleft. In addition to needing plastic surgery to repair the opening, these children may have problems with their feeding and their teeth, their hearing, their speech, and their psychological development as they grow up.

For that reason, parents should seek the help of a Cleft Lip and Palate Team as early as possible. Medical professionals with special experience in the problems of cleft lip and palate have formed such teams all over the country to help parents plan for their child’s care from birth, or even before. Typically, a Cleft Team might include a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, a social worker, a hearing specialist, an ear-nose-throat specialist, a psychologist, a nurse, and a genetic counselor.

When surgery is done by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.

In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.

At your initial consultation, your doctor will discuss the details of the procedure he or she will use, including where the surgery will be performed, the type of anesthesia to be used, possible risks and complications, recovery, costs, and the results you can expect. Your surgeon will also answer any questions you may have about feeding your baby, by breast or by bottle, both before and after the surgery.

A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.

To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal “cupid’s bow” shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.

Your child may be restless for a while after surgery, but your doctor can prescribe medication to relieve any discomfort. Elbow restraints may be necessary for a few weeks to prevent your baby from rubbing the stitched area.

If dressings have been used, they’ll be removed within a day or two, and the stitches will either dissolve or be removed within five days. Your doctor will advise you on how to feed your child during the first few weeks after surgery.

It’s normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it’s barely noticeable because of the shadows formed by the nose and upper lip.

In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.

To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.

For a day or two, your child will probably feel some soreness and pain, which is easily controlled by medication. During this period, you child will not eat or drink as much as usual — so an intravenous line will be used to maintain fluid levels. Elbow restraints may be used to prevent your baby from rubbing the repaired area. Your doctor will advise you on how to feed your child during the first few weeks after surgery. It’s crucial that you follow your doctor’s advice on feeding to allow the palate to heal properly.

Children with a cleft palate are particularly prone to ear infections because the cleft can interfere with the function of the middle ear. To permit proper drainage and air circulation, the ear-nose-and-throat surgeon on the Cleft Palate Team may recommend that a small plastic ventilation tube be inserted in the eardrum. This relatively minor operation may be done later or at the time of the cleft repair. In addition, surgery may be recommended by your plastic surgeon when your child is older to refine the shape and function of the lip, nose, gums, and palate.

You’ll want to discuss further needs with the members of the Cleft Team seeing your child.
Perhaps most important, keep in mind that surgery to repair a cleft lip or palate is only the beginning of the process. Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect.

Craniofacial Syndromes

Craniofacial syndromes are deformities in the growth of the head and facial bones. These deformities are usually congenital, meaning babies have them at birth. Craniofacial syndromes are complex. At the HAPSI, our specialty-trained surgeons have the experience necessary to treat these syndromes. Some of the craniofacial syndromes we treat include the following:

Apert syndrome is when your child has an abnormal head shape, a small upper jaw, and their fingers and toes are fused together.

Crouzon is a birth defect that causes a child’s skull to be short in the front and back. Children with crouzon often also have flat cheek bones and a flat nose.

Goldenhar’s syndrome affects the development of the ear, nose, soft palate, and lip, causing these features to be undeveloped. It also affects the bones that form the lower jaw (mandible). 

This syndrome causes the lower half of a child’s face to be underdeveloped. It usually affects the ears, mouth, and the lower jaw.

Pfeiffer syndrome cause differences (or abnormalities) in a child’s skull, hands, and feet.

The three main symptoms of this condition are a cleft palate, a small jaw, and airway obstruction. Airway obstruction is when something blocks your child’s airway, which causes breathing problems.

The symptoms of this syndrome can affect each child differently because it affects how the bones and tissues inside a child’s face develop. Most people with Treacher-Collins have underdeveloped facial bones and a small jaw and chin.