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The team includes 26 specialists from 14 health specialties, including genetics, pediatrics, otolaryngology, neurosurgery, ophthalmology, plastic surgery, pediatric dentistry, orthodontics, prosthodontics and oral and maxillofacial surgery. Other essential services include social work, speech pathology and audiology and nutrition.
The team's goal is to provide the best treatment available today. Each team member is experienced in treating children with cleft lip, cleft palate and other craniofacial disorders.
They come together to evaluate each patient’s current medical, dental and psychosocial development and make recommendations for how best to coordinate care and treatment. Team members are skilled in the use of distraction osteogenesis (DO), which has revolutionized craniofacial surgery.
The Texas Cleft-Craniofacial Team follows guidelines established by the American Cleft Palate-Craniofacial Association and those of the Texas State Department of Health's Special Health Care Needs Services Program.
In keeping with the guidelines, children should have periodic evaluations beginning shortly after birth and continuing throughout the growing years, until the age of 21. This allows the team to view your child’s development and adjust treatment plans accordingly.
Learn more about:
Cleft Lip and Palate
Cleft lip and palate are among the most common congenital deformities seen in children. Our first concern is the infant's ability to eat, which we ensure through the services of a speech therapist and, if necessary, a pediatric dentist.
The speech therapist instructs parents in the use of various nipples; if the child is unable to eat with a nipple, the pediatric dentist constructs an obturator to seal off the child's cleft palate to improve sucking ability.
Once your child is able to eat, we make preparations for lip surgery, which is usually done at 3 to 4 months of age. Before surgery, the dentist will fashion an obturator with one or two nasal prongs to help reshape the flip, nose and palatal bones. When pre-nasal alveolar molding is completed, the child will be ready for surgery, which normally takes 2 to 3 hours.
The next step is palate repair, which is usually completed at 9 to 12 months of age. Before surgery, we will check your child’s hearing. For infants with persistent infection or fluid in their ears, an otolaryngologist will place ventilation tubes before surgery. Most children remain in the hospital for at least a day following surgery or until they are eating and drinking well.
Repair of the bony cleft in the child’s gum is normally the next step in treatment. Surgery is scheduled at 7 to 12 years of age. Frequently, pre-surgical orthodontic work is necessary before bone grafting of the bony cleft. Bone for the graft is usually taken from the child’s hip. Children typically stay in the hospital for one night after the surgery.
The final step in treatment for cleft lip and palate involves surgery on the nose and midface, which is usually done when children have completed their growth (age 14 to 16 for girls and 16 to 18 for boys). Preparation for surgery at the midface often involves several years of orthodontic treatment. Nasal surgery is normally done following the midface bone surgery.
Craniosynostosis
Craniosynostosis is the premature closure of one of more sutures in the infant’s skull. In older children and those with multiple suture synostosis, extensive reconstruction of the craniofacial skeleton is required. This involves an ear-to-ear incision in the scalp.
The affected suture is removed, and the surrounding bones are correctly positioned using small absorbable plates and screws. Surgery normally lasts 2 to 4 hours, with 3 to 5 days of hospitalization.
For children who are less than 2 months old, we use a new endoscopic approach. This involves limited incisions in the scalp and removal of the affected sutures through an endoscope. Surgery usually lasts 1 to 2 hours, with 1 or 2 days of hospitalization.
Position-induced Head Shape Abnormalities
Infants with positional deformities or plagiocephaly are born with a variety of different head shapes. Deformities may result from positioning during pregnancy, sleeping position or from neck tightness.
An asymmetrical skull can result in asymmetries of the face, which can affect chewing, speech, breathing and vision. Some deformities can be managed with proper positioning, but if a deformity persists, treatment may be necessary.
In infants, treatment involves using a molding cap and is best done during the first 6 months of life. The cap is worn 23 hours a day for 3 to 4 months; treatment usually results in a 70 percent rate of improvement. Severe cases in older children may require longer treatment periods.
Congenital Facial Anomalies
Congenital deformities that affect the face and upper and lower jaws may include Apert, Crouzon, Treacher-Collins, Pierre Robin Complex and hemifacial microsomia syndromes, among other disorders. Treatment initially focuses on the ability to breathe and eat normally. Surgical treatment is usually delayed until adolescence in some patients with mild deformities. Recently, distraction osteogenesis has been used to treat patients at an earlier age.
Distraction Osteogenesis
Distraction osteogenesis (DO) has revolutionized craniofacial surgery. DO involves cutting bone and then slowly moving the cut ends of the bone, which causes new bone formation in the resulting gap. Distraction osteogenesis can be used in the lower jaw (mandible), upper jaw (maxilla) and face. A number of distraction devices are commercially available.
Contact Information
The Texas Cleft-Craniofacial Team meets in Suite 1400 of the UT Professional Building at 6410 Fannin. For more information or to schedule an appointment, please call 713-500-7302.
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