craniofacial surgery

Cleft Lip/Cleft Palate are conditions that happen before birth. A cleft lip is an opening in the upper lip that occurs when the tissue that makes up the lip does not join completely before birth. A cleft palate occurs in the roof of the mouth/palate when the tissue does not completely join together before birth. Either one or both of these conditions can happen on their own or as part of a craniofacial syndrome. The surgery to repair these conditions is routinely performed by our surgeons here at the center.

Cranial Vault Distraction treats patients with craniosynostosis, which is a condition that occurs when the bones in a baby’s skull join together too early before the brain is fully formed. The process reshapes the skull bones with the goal of expanding the cranial vault space to allow the brain to grow without limitation. Distraction of the cranial bones can also offer protection for the eyes. For example, patients with craniosynostosis syndromes, such as Apert, Crouzon, Pfeiffer, Muenke and other similar syndromes may sometimes require this type of distraction.

Midface (LeFort) Jaw Surgery involves fracturing/moving the upper jaw (maxilla) and often bones of the cheeks and orbits. Midface movement is frequently needed in patients with cleft-related and other craniofacial syndromes. The growth disturbances can often lead to severe apnea, poor feeding and altered appearance. Midface surgery can improve breathing and feeding, contribute to eye protection and overall improved aesthetics. Surgeries that improve/enlarge the airway may eliminate the need for a tracheostomy.

Internal Mandible Distraction is a technique performed to lengthen the lower jaw (mandible) bone. The bone is surgically separated with the placement of internal hardware on each side of the separation. Over a period of several days up to one month, two visible activation rods behind each ear are turned a few times daily to distract the lower jaw forward. Once the distraction process ends, the activation rods are removed. The internal hardware remains in place for a period of weeks to a few months while the new bone hardens (consolidates). The hardware is then removed in a short surgery. This type of distraction eliminates the need for external facial hardware and is suitable for multiple treatment plans.

Two-Pin External Mandible Distraction uses external hardware to distract the lower jaw (mandible). Following the surgical separation of the lower jaw bone, two long metal pins are inserted through the upper and lower bone horizontally and then stabilized. Activation rods on the device are turned over a period of several days or more to lengthen the bone in a purposeful downward direction. Once the desired length is achieved, the device is removed in a brief surgery and the lower jaw is repositioned. This approach is most often used in a younger patient population including newborns. It can be performed to avoid a tracheostomy at birth in certain situations.

Minimally Invasive Facial Distraction (MIFD) uses a rigid external distraction (RED) device to reshape the upper (maxilla) and lower jaw (mandible). The goal is to improve the airway and avoid the need for a tracheostomy, often referred more simply as a trach. This minimally invasive technique has a high success rate for improving the airway. A halo type device is attached to the child’s skull and stabilized. Foot plates are anchored to the upper and lower jaws through the mouth and under the chin to avoid visible scarring. The activation rods are turned daily for a few weeks to achieve desired results. Depending on the patient, the RED device halo may stay in place for four to seven weeks to allow bone hardening (consolidation). This unique procedure may allow for a bigger airway and more bone growth than some traditional devices can achieve. Improved aesthetics is another desirable outcome of this method. Treacher Collins, Nager, and Goldenhar are only a few of the syndromes benefiting from this type of distraction.