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Portland, Oregon and Vancouver, Washington Craniofacial and Cleft Palate Surgery

As both physicians and dentists, the surgeons at Head and Neck Surgical Associates are uniquely qualified to manage all phases of surgical care for patients born with cleft lip or other craniofacial abnormalities. Children with these complex congenital deformities require a team approach to their management, including surgery, speech pathology, orthodontics, pediatric dentistry, genetics, occupational therapy, and developmental pediatrics. Recognizing the need for such a group, Dr. Eric Dierks and Dr. Bryce Potter founded the Emanuel Cleft Lip / Palate Team in 1991. At the practice of Head and Neck Surgical Associates, serving patients from Oregon and across the Northwest, the latest in craniofacial and cleft palate surgery continues to be provided.

At Head and Neck Surgical Associates, we feel the cleft surgeon must have degrees in both medicine and dentistry to render the most effective and comprehensive care. Our surgeons, as well as our medical staff, regard “clefting” as simply a variation of nature and do not assign the terms “normal” vs. “abnormal” to children with cleft lip or palate needs. Early parental education and support is a critical element of the overall successful management of a cleft child. Parents who have recently discovered by ultrasound examination that they have a child with a cleft make an understandable and important adjustment to this finding. Our doctors and staff look forward to interacting with pregnant parents of a cleft child and help them through the process of learning about clefting and related treatments well before birth. Therefore, parents can be fully informed and prepared prior to childbirth, knowing that their newborn will be properly cared for by highly skilled and experienced surgeons.

In conjunction with members of the Craniofacial Center at Legacy Emanuel Hospital and Health Center of Portland, Oregon, our surgeons provide craniofacial surgery to treat congenital and acquired deformities of the craniofacial skeleton and soft tissues. These disorders include craniosynostosis, Apert’s Syndrome, orbital hypertelorism, temporomandibular joint (TMJ) disorders, Crouzon’s Syndrome, Treacher-Collins Syndrome, facial clefts, dental-facial deformities, and facial tumors. The surgical team examines patients and discusses treatment plans weekly, allowing patients to see most or all related specialists in a single visit.

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Treatment Protocol: Cleft Lip and Palate

Month One

A visit to our clinic will be needed for a general pediatric evaluation with emphasis on feeding difficulties, hearing problems, genetic counseling, dental evaluation and possible construction of dental splints or prosthesis, emotional support services, and evaluation and planning for surgery. Orthodontic preparation is begun at this time.

Month Three

Cleft lip repair is performed. 

Months Three to Twelve

The construction of further dental splints is undertaken, if indicated. One or more hearing / ear evaluations, as well as a speech evaluation, are performed.

One year of Age

Cleft palate repair is performed and ear tubes are placed, if necessary.

One to Five Years of Age

Periodic (e.g., annual or bi-annual) clinic evaluations of speech are recommended (if needed, speech therapy is started through school or clinic). Hearing, dentition, and social and emotional development are evaluated.

Occasionally, palate and lip revision surgery is required during this period. Frequently, this surgery is combined with nasal surgery that is performed before the child starts school. Every attempt is made to minimize the child’s deformity prior to beginning school.

Five to Nine Years of Age

Cleft patients typically require orthodontic preparation for surgical bone graft of the cleft in the palate before permanent teeth erupt. At our Portland, Oregon practice, this craniofacial surgery is performed during this period. With adequately orthodontic preparation, the bone graft procedure is performed by moving bone from the hip to the bone hole in the palate. Also, speech assessment is continued during this time.

Nine to Twenty Years of Age

Orthodontic treatment is continued, and, if necessary, minor lip and nose revisions are performed. When the jaw is fully grown (typically in the late teen years) jaw and final nasal surgery is performed, if necessary.

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Treatment Protocol: Craniofacial Disorders

(There are many different types of craniofacial anomalies and therefore this protocol is meant to be a general outline only.)

Month One

Clinic visit for general pediatric evaluation with emphasis on feeding difficulties, hearing problems, genetic counseling, dental evaluation, eye evaluation and possible construction of dental splints or prostheses, emotional support services and evaluation and planning for surgery is recommended. X-rays and CAT scans are typically performed to define the exact nature of the disorder.

Three to Six Months of Age

Helmet therapy is begun to remodel the skull for babies with “crooked” skulls or plagiocephaly.

Six to Twenty Four Months of Age

Surgery may be needed to remold and reshape the skull or upper face. Our Portland, Oregon craniofacial surgery experts perform this procedure in conjunction with a neurosurgeon, usually when the patient is 6 to 12 months of age. For children with poor skull growth, a second operation is considered during this period to ensure that brain growth is not restricted. In general, we try to correct the skull defects as soon as possible to take advantage of the younger child’s advantage in healing and remodeling bone.

Two to Five Years of Age

For children with jaw deformities such as hemifacial microsomia, jaw stretching or distraction is typically performed at this age. Distraction typically requires two surgeries, one to place the instrument and one smaller operation to remove it. Our Oregon craniofacial surgery experts routinely uses distraction instruments placed totally inside the mouth to avoids scars on the cheek whenever possible.

For children with impaired facial growth (typically seen in Apert’s, Crouzon’s and other disorders) facial advancement surgery is performed during this period.

Also during this period, speech, dental, eye, and ear evaluations are performed annually or bi-annually as needed.

After Five years of Age

Close, continued evaluation of speech, teeth, eyes, and ears are performed on an annual or bi-annual basis as needed. Orthodontic treatment at our Portland practice is begun if necessary, leading toward final nasal and corrective jaw surgery late in the teenage years.

To speak with our staff serving Portland, Oregon and Vancouver, Washington in order to learn more about craniofacial surgery, corrective jaw surgery, cosmetic surgery, or any of our many other practice areas, contact Head and Neck Surgical Associates today.

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