When a child has a traumatic injury or birth defect, it can be difficult for parents when they don't know what to expect. At Yale Medicine, our craniofacial surgical specialists provide you with the support you need, in part, through detailed answers and by thoroughly explaining your child’s condition and treatment options. 

In the vast majority of cases, craniofacial surgeries are performed on infants and children who were born with or later developed a skull or facial abnormality. Surgery may also be performed on someone who has sustained a traumatic injury in an accident or has a non-congenital condition like a tumor or blood vessel developmental abnormalities.

Craniofacial surgery techniques may be used to treat urgent, life-threatening conditions as well as important “quality of life” reconstructive procedures.

Craniofacial surgery refers to a series of surgical procedures involving the skull and the face. Most patients have developmental or congenital conditions such as cleft lip or cleft palate and syndromes that affect the facial regions around the eyes, ears, or jaw.

One such condition is craniosynostosis, a rare defect in which the bones in the baby's skull fuse together earlier than normal. This can influence the shape and function not only of the rest of the skull, but also the brain.

Some forms of craniosynostosis also result in irregularities in the middle of the face, such as around the eyes, and upper and lower jaws.

“The brain needs a certain amount of space to grow, and if the bone is restricted, this may cause damage or problems for optimal neurological development,” says John A. Persing, MD, chief of Yale Medicine Plastic and Reconstructive Surgery and director of the Yale Medicine Cosmetic Surgery Center.

Craniofacial surgery may also be used to treat trauma-related injuries of the face or skull, or post-tumor reconstruction. In all cases, the goal is to restore normal appearance and function to the face of the child or adult.

The craniofacial program specialists are also trained to keep an eye out for related issues. For example, some children with cleft lip and/or cleft palate may have irregularities in other parts of body developing around the same time, such as abnormalities related to the heart and kidney.

Many of conditions that require craniofacial surgery are detected by clinical exam in the first few weeks to months of life.

Skull irregularities in infants don't always signify a serious underlying problem, says Dr. Persing. For example, a baby who always sleeps on his or her back may develop some flattening in the back of the skull, which often mimics a serious irregularity such as craniosynostosis.

Generally speaking, abnormal head shapes are common in naturally delivered newborns. If skull irregularities persist after the first few weeks or become more severe, review by a pediatrician or family doctor is appropriate. The pediatrician can make this referral when necessary.

Not every skull abnormality needs to be evaluated by imaging tests or a specialist’s clinical exam.

“If surgery isn't required, we can help figure out how to most effectively deal with skull irregularities, so the child does not continue to have them for the rest of his or her life,” says Dr. Persing.

The general approach of the craniofacial surgeon is to try to minimize scarring and avoid persistent defects. “Young skin is more prone to scar widening, as it is thinner and ‘weaker’ than adult skin,” says Dr. Persing. 

Surgeons use methods that allow them to make smaller and less visible incisions, operating, when applicable, with specialized endoscopes, and utilizing strategic and relatively hidden placement of incisions.

In cases of craniosynostosis, Dr. Persing and his team are mindful of avoiding permanent scarring on the forehead.

“We recognize that sometimes we have to modify the skull and facial bones, so we try to do that in a way that leaves the least visible trace,” Dr. Persing says. “Placing an incision behind the hairline, particularly in the posterior scalp, gives us a great deal of visibility and flexibility while operating.”

When removing benign tumors, the same principle applies. “We try to make the incision invisible, like inside the lips or eyelids when possible or in a natural crease line in the face that a person would have anyway, so that the scar is very difficult to spot later on,” says Dr. Persing.

Since many craniofacial conditions can influence appearance and function, periodic review throughout adolescence is recommended.

Craniofacial program specialists are trained to keep an eye out for related issues. For example, children with cleft lip and cleft palate may have irregularities in other parts of body, such as issues related to the heart and kidney, which are developing around the same time. After treating a patient's craniofacial problems, he or she may be referred to other specialists to monitor their kidney function.

Children may need to work with a speech therapist to help with swallowing and eating. He or she may need to be monitored to ensure that teeth, the lips and the tissues of the face are all growing normally.

“This is a process that goes on for many years,” says Dr. Persing.  "Patients build a family connection with their team. We want to be sure that the children are still being treated optimally as they go through life."

The Yale Medicine craniofacial program provides patients and families with comprehensive care.

We recognize that it can be stressful for a family to figure out how to coordinate all of the services for the care of their child. Families who come to the Craniofacial, Oral and Dental Center at Yale New Haven Children’s Hospital are supported throughout the process by the administrative and clinical staff.

Patients can expect to be seen by internationally-renowned specialists, including plastic surgeons, neurosurgeons, dentists, psychologists, otolaryngologists, pulmonologists, anesthesiologists, sleep and intensive care specialists, social workers, and speech and feeding specialists, among others.

The Craniofacial, Oral and Dental Center also partners with the Yale Medicine Child Study Center to help define the basis for the best care available and to chart future improvements in treatment.