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Learning that your child may need one or more surgeries to help treat a craniofacial condition can feel frightening.
At UPMC Children's Hospital of Pittsburgh, we're here for you and your family each step of the way.
Our team of specialists at the Cleft-Craniofacial Center:
The goals of craniofacial surgery are to improve the function of the head and face and to normalize appearance and improve self-image.
The type of surgery your child requires depends on the type and severity of their condition. Some children will require more than one procedure depending on their diagnosis.
Craniofacial surgeries are divided into:
Cranial surgeries are performed in children with craniosynostosis to improve the shape of the skull and provide enough space so the brain can work at its best. There are two main types of cranial surgery: open procedures and minimally invasive procedures.
Open procedures are performed in children who need more extensive operations and who are most often 9 months old or older.
In an open procedure, your surgeon will:
Each of these surgeries takes about 4 to 6 hours.
Your child will likely spend several days in the hospital after surgery including 1 day in the intensive care unit.
This surgery corrects the shape of the forehead — or front of the skull (fronto) — and the top of the eye sockets (orbital).
During the procedure, surgeons:
Anterior refers to the front of the skull, and cranial vault refers to the skull itself.
This technique aims to make more space inside the front of the skull.
Surgeons remove the front part of the skull, reshaping it or adding bone grafts to make it larger without reshaping the top of the eye sockets.
Some types of craniosynostosis keep the skull from growing wide enough for the brain.
This surgery reshapes the middle part of the skull, right above the ears, to make enough room for the brain.
This surgery is often used for children who are older with close to normal head shapes but who still need extra space for their brains to function normally.
This surgery corrects the bones in the back part of the skull when it's too flat, or long and narrow.
Surgeons reshape the bones to make the back of the head rounder.
Doctors use this technique to treat patients with lambdoid sagittal craniosynostosis.
Surgeons often use this method for children with sagittal craniosynostosis.
In this procedure, surgeons make the skull more round by correcting several places at once. This makes the skull wider, taller, and less elongated in one surgery.
This procedure is most often performed in children 6 to 9 months of age.
The word “distraction" means to apply a device that separates bones over time. “Osteogenesis" means to make new bone.
Distraction techniques allow the skin to stretch as the bones expand and form over time. These procedures can expand the skull more than non-distraction techniques and are used for severe cases.
Surgeons need to open the skin from ear to ear so they can see the tissues and structures below.
During this surgery, the surgeon:
In minimally invasive techniques, surgeons:
In order to see everything through smaller incisions, surgeons will sometimes use an endoscope, so these procedures are often called “endoscopic-assisted" or “endo" surgery.
They rely on the natural growth of the brain to help reshape the skull, so children are younger who undergo this surgery. These surgeries most often require something to help reshape the skull, such as a helmet or springs.
This minimally invasive surgery is most often used for children with sagittal craniosynostosis.
During this procedure, the surgeons:
The springs are removed 4 months later in a short, same-day surgery.
Another minimally invasive method to treat patients with craniosynostosis involves removing the fused suture and using an orthotic helmet to help reshape the skull. This is sometimes referred to as “endo with helmet."
As with springs, the surgeon removes a small piece of bone from the suture that fused prematurely in a short 1 to 2 hour surgery. Children will typically go home the following day.
After surgery, your child will wear a helmet custom made for their head. The helmet will help the skull to form a more normal shape. Most helmets are worn for 6 to 12 months after surgery.
Frontofacial surgeries help correct abnormal facial features caused by syndromic forms of craniosynostosis or other craniofacial conditions. Their goals are to:
These are complex procedures that are either performed using distraction techniques or as an “all at once" movement.
The Lefort I moves the bones of the upper jaw and teeth. Surgeons use this to help improve the bite, the airway, and the relationship between the upper lip and teeth.
During Lefort I procedures, surgeons:
The Lefort II procedure moves the nasal bones and upper jaw forward without moving the cheekbones or eye orbits.
During Lefort II, surgeons:
The purpose of a Lefort III procedure is to move the cheekbones, lower part of the eye sockets, and upper jaw into a better position.
Surgeons start this surgery by making incisions on the top of the head and inside the mouth. They then cut and separate the bones in this part of the facial bones from the skull.
Surgeons can perform Lefort III with or without distraction osteogenesis.
When distractors are used, a device will be fixed to the outside of the head with pins and attached to the face by wires. This is called a “halo distractor."
Your team will teach you how to tighten the wires over time and slowly pull the facial bones forward. Once the bones are in a good position, the halo distractor remains in place for a few months until the bones heal.
When this surgery is performed without distraction, bone grafts will be used to fill the spaces that result from moving the facial bones forward.
The Monobloc technique aims to move the forehead, eye sockets, cheekbones, and upper jaw into a better position.
Most often surgeons separate the bones and use distractors to move the bones into the final position.
In this procedure, a device will be fixed to the outside of the head with pins and attached to the face by wires. This is called a “halo distractor."
The Facial bipartition technique is similar to the monobloc technique but also involves separated the facial bones down the midline.
This allows the surgeon to adjust the position and shape of the eye sockets and upper jaw as well as moving the bones into a better position.
The Four wall box osteotomy is a technique that is used to change the position of the eye sockets without moving the upper jaw.
Similar to the other frontofacial procedures, surgeons use an incision in the scalp and in the mouth to access the bones around the orbits. The forehead bone is removed to find the tops of the eye sockets so that they can be moved into a better position. The bones are then reattached using plates and screws.
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
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