Diagnosis & Treatment
How We Diagnose Craniofacial Disorders
If a prenatal ultrasound is suggestive of a craniofacial disorder, our team meets with the expecting parents to provide support and plan a course of action after the baby is born.
Evaluations for Infants and Children
Your appointment includes a complete assessment of your child’s health and function. Because disorders of the face and skull can involve more than just the child's appearance, systemic evaluation, genetic analysis, and familial planning are all available when appropriate.
How We Treat Craniofacial Abnormalities
At NewYork-Presbyterian, renowned Columbia University and Weill Cornell Medicine pediatric neurosurgeons collaborate with specialists in plastic and craniofacial, oral surgery, ear/nose/throat surgery, and eye surgery to provide expert, customized care to children with craniofacial conditions.
Surgery for Craniosynostosis
Surgery is the only effective treatment for craniosynostosis, because fused sutures (bones of the skull) must be opened to allow the brain to expand. A skilled surgeon must create new openings in the skull to allow for the rapid brain growth that takes place in the first year of life. The surgery is very safe and produces excellent results.
There are several surgical options for treating craniosynostosis, depending on which type it is. It’s usually best to perform surgery at just a few weeks to a few months of age, since the skull bones are the softest and most malleable then. The craniofacial team that evaluates a child will recommend the best surgery based on which suture closed prematurely and the degree of deformity. These include:
- Traditional open surgical procedures are called cranial vault remodeling and vertex craniectomy, which are extremely safe and produce excellent results. In this surgery, a neurosurgeon removes the affected or closed suture and then “remodels” the skull. The surgery usually takes between two and six hours and requires three to five days in the hospital, depending on the age of the child and which suture is involved. Some children need blood transfusions during the surgery and a compatible parent may donate his or her blood to be used in the event that a transfusion is needed. No helmet therapy is needed after traditional surgery.
- Endoscopically assisted strip craniectomy (also called endoscopic assisted suturectomy) is a newer, minimally invasive approach to craniosynostosis surgery. As in the traditional approach, a neurosurgeon removes the closed suture – but unlike the traditional approach, the endoscopic procedure does not include cranial remodeling during surgery. This minimally invasive procedure is typically performed on infants younger than three months of age, since it depends on extremely rapid brain growth to help reposition the cranial bones. Endoscopic assisted suturectomy usually takes less time in the operating room and requires a shorter hospital stay. After endoscopic surgery for craniosynostosis, the child will wear a cranial remodeling helmet to help reshape the skull.
Facial and Cranial Reconstruction
- Our plastic and craniofacial surgeons perform reconstruction of facial clefts (including cleft lip and cleft palate), cleft lip revision, ear malformations (such as microtia), facial asymmetry, craniosynostosis, and a variety of other facial and cranial abnormalities. We perform surgeries on children with congenital asymmetry of the upper and lower jaw.
- In children in whom bone abnormalities cause irregularities in the shape of the skull or facial features, our plastic surgeons, working with other members of the craniofacial treatment team, can shift these bones of the head and face into more natural positions. Sometimes we achieve these changes gradually through a technique known as "distraction osteogenesis," providing these children with a more functional and cosmetically appealing result.
- Our oral surgeons, trained in pediatric oral surgery, perform maxillofacial reconstruction, primarily of the bone and teeth, including the treatment of children who've acquired a deformity from trauma, tumors, or congenital abnormalities. They perform surgery to correct facial asymmetries and to adjust the alignment of the jaws and other facial structures as children grow.
- In children with craniofacial abnormalities, oral surgeons are involved in reconstructing the lower jaw and the upper jaw — usually below the level of the eye. For instance, a child who has a cleft lip and palate may be missing bone in the cleft and upper jaw near the teeth. An oral surgeon will perform a bone graft to reconstruct this section.
- Our prosthodontists also perform presurgical procedures such as nasoalveolar molding (NAM), expanding the palate and preparing your child's bite to ensure stability after surgery and correcting jaw discrepancies and dental arches before cleft lip and palate surgery.
- Oral surgeons also perform procedures to correct abnormal growth of the upper jaw or deformity of the lower jaw.
- Our otolaryngologists (ear, nose, and throat specialists) evaluate and care for children with hearing, swallowing, and respiratory problems related to craniofacial conditions.
- Many children have ear fluid or congenital abnormalities that interfere with their hearing. Otolaryngologists can identify these problems; perform surgery to treat any correctible hearing issues; and offer hearing aid support, including specially designed hearing aids based on cutting-edge technology and cochlear implants for children who can benefit.
- Our otolaryngologists also evaluate and treat upper airway problems, since craniofacial conditions can impact breathing. They use flexible scopes which allow them to perform these evaluations even in very small infants.
- Our Craniofacial Program also features oculoplastic surgeons, who perform reconstruction of eye structures.
Timing of Surgery
If your child is having surgery for a craniofacial disorder, it's important that we time your child's surgery to minimize the impact of the craniofacial abnormality on cranial and facial growth, development, function, and appearance. Some children require reconstructive procedures at different times in their growth and development. Understanding the rationale for the timeline for reconstructive surgery and other procedures, including the use of orthodontics, is helpful to families, and our team members explain the process to you every step of the way.
- If a newborn has a cleft lip and palate, we usually perform lip repair surgery at about two to three months of age, followed by palate repair between the ages of six and 15 months.
- When the child approaches school age, he or she may have another surgery on the back part of the palate to improve speech.
- Between the ages of six and 10, we may perform a bone graft.
- At 15 or 16 years, we may reposition the upper jaw, if needed.
We may perform lip and nose surgery to improve appearance in early and late adolescence, if not sooner. Throughout this process, the child may have orthodontic therapy to widen the upper jaw or put in a palate expander, and will also see a pediatric dentist to make sure the teeth and gums are in good health and to maintain oral health.