Pediatric Conditions

Toll-Free: 866.320.4573

Call Us Toll Free:

866.223.2273 x1234

Some children are born with complex abnormalities that affect the appearance and growth of the face and skull. These congenital problems may also involve the brain, heart, lungs, liver or gastrointestinal tract, and they may affect the appearance and function of the hands and feet.

If the bone sutures in the face or skull are fused rather than open, the face and skull cannot grow normally. This condition is called craniosynostosis, which can result in an abnormal appearance of the face and/or skull. Rarely, children may experience brain dysfunction and abnormal development due to increased intracranial pressure, or pressure within the skull.

BEFORE and AFTER pediatric patient images

Click through the following Cleveland Clinic patient images to see before and after surgical results

Before

After

before after

Patient is shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Profile view of same patient shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Top view of same patient shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Patient is shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Profile view of same patient shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Top view of same patient shown before surgical correction for craniosynostosis (left), and five months following procedure (right).

before after

Patient is shown before surgical correction for craniosynostosis (left), and one year following procedure (right).

before after

Patient is shown before surgical correction for craniosynostosis (left), and one year following procedure (right).

before after

Patient is shown before surgical correction for craniosynostosis (left), and one year following procedure (right).

before after

Patient is shown before craniosynostosis surgery (left), and four months following surgery (right).

before after

Patient is shown before craniosynostosis surgery (left), and four months following surgery (right).

before after

Patient is shown before craniosynostosis surgery (left), and four months following surgery (right).

before after

Front view of 8 week old patient diagnosed with metopic craniosynostosis. Patient underwent endoscopic surgical correction at 10 weeks of age through a 2.5 cm skin incision. Surgery was approximately two hours long. Patient was discharged home the next day. Patient pictured before procedure (left), and one year after procedure (right).

before after

Side view of 8 week old patient diagnosed with metopic craniosynostosis. Patient underwent endoscopic surgical correction at 10 weeks of age through a 2.5 cm skin incision. Surgery was approximately two hours long. Patient was discharged home the next day. Patient pictured before procedure (left), and one year after procedure (right).

before after

Side view of 8 week old patient diagnosed with metopic craniosynostosis. Patient underwent endoscopic surgical correction at 10 weeks of age through a 2.5 cm skin incision. Surgery was approximately two hours long. Patient was discharged home the next day. Patient pictured before procedure (left), and one year after procedure (right).

before after

Four month old patient born with sagittal craniosynostosis. Patient underwent open surgical correction. Patient is shown before the procedure (left), and again three months after the procedure (right).

before after

Left side view of four month old patient born with sagittal craniosynostosis. Patient underwent open surgical correction. Patient is shown before the procedure (left), and again three months after the procedure (right).

before after

Right side view of four month old patient born with sagittal craniosynostosis. Patient underwent open surgical correction. Patient is shown before the procedure (left), and again three months after the procedure (right).

before after

Top view of four month old patient born with sagittal craniosynostosis. Patient underwent open surgical correction. Patient is shown before the procedure (left), and again three months after the procedure (right).

before after

Six week old patient born with left coronal craniosynostosis. Patient underwent endoscopic repair of her craniosynostosis through a 3-cm skin incision. Patient was discharge home the next day. Patient is shown before the procedure (left), and one year after surgery (right).

before after

Right side view of six week old patient born with left coronal craniosynostosis. Patient underwent endoscopic repair of her craniosynostosis through a 3-cm skin incision. Patient was discharge home the next day. Patient is shown before the procedure (left), and one year after surgery (right).

before after

Top view of six week old patient born with left coronal craniosynostosis. Patient underwent endoscopic repair of her craniosynostosis through a 3-cm skin incision. Patient was discharge home the next day. Patient is shown before the procedure (left), and one year after surgery (right).

How are congenital craniofacial facial problems corrected?

Surgery to correct these facial and skull abnormalities involves releasing bones and moving them to a position that will allow more normal growth. Some of the more complex craniofacial problems require several carefully performed surgeries during infancy, childhood and adolescence of the patient. Cleveland Clinic plastic surgeons use biomodeling techniques to help plan complex reconstructive surgery for children with congenital craniofacial deformities and skull base tumors.

Craniofacial-Orbital Clinic

Cleveland Clinic’s Craniofacial-Orbital Clinic provides interdisciplinary assessment, including pre- and postoperative management of infants, children, adolescents and adults with cranial and orbital deformities. Care is provided by specialists in craniofacial plastic surgery, neurosurgery and oculoplastic surgery.

At Cleveland Clinic, children with congenital craniofacial problems are specially cared for by a team of experts that includes a pediatrician, neurosurgeon, plastic surgeon, orthodontist, dentist, speech and language specialist, hearing specialist, otolaryngologist, psychologist, genetic counselor and nurse.

Learn More

To learn more about reconstructive surgery treatment options for pediatric conditions at Cleveland Clinic, please call 216.444.4646 or 800.223.2273 ext. 44646.

One out of 800 babies is born with an incomplete fusion of either the lips or roof of the mouth. An incomplete fusion of the lip is called cleft lip, and an incomplete fusion of the roof of the mouth is called a cleft palate.

Both cleft lip and cleft palate can be repaired successfully. However, if left untreated, a cleft lip or cleft palate can interfere with normal growth and function of the mid-face and mouth. Problems with facial growth, and speech and oral competence can develop.

At Cleveland Clinic, a child with a cleft lip or cleft palate is specially cared for by a team of experts that includes a pediatrician, plastic surgeon, oral surgeon, orthodontist, dentist, speech and language specialist, hearing specialist, otolaryngologist, psychologist, genetic counselor and nurse.

BEFORE and AFTER Cleft Lip Patient Images

Click through the following Cleveland Clinic patient images to see before and after surgical results.

Before

After

before cleft lip repair after cleft lip repair

Patient is shown before cleft lip repair (left), and 13 days following surgery (right).

before cleft lip repair after cleft lip repair

Close-up view of same patient before cleft lip repair (left), and 13 days following surgery (right).

before after

Patient is shown before cleft lip repair (left), and three months following surgery (right).

before after

Close-up view of same patient before cleft lip repair (left), and three months following surgery (right).

before after

Patient is shown before cleft lip repair (left), and seven months following surgery (right).

before after

Close-up view of same patient before cleft lip repair (left), and seven months following surgery (right).

before after

Two week old patient diagnosed with complete left cleft lip and palate. Patient underwent surgeries to repair the cleft lip, nose and palate. Patient is shown before surgeries (left) and eight months after surgery for cleft lip repair (right).

before after

Close-up view of same patient. Patient was diagnosed with complete left cleft lip and palate. Patient underwent surgeries to repair the cleft lip, nose and palate. Patient is shown before surgeries (left) and eight months after surgery for cleft lip repair (right).

before after

One week old newborn male with complete left cleft lip before cleft lip repair (left), and six months after cleft lip repair (right).

before after

Close-up of same one week old newborn male with complete left cleft lip before cleft lip repair (left), and six months after cleft lip repair (right).

before after

Three week old patient diagnosed with left incomplete cleft lip and palate. Patient underwent surgery to repair the cleft lip. Patient is shown before surgery (left), and four months after surgery (right).

before after

Close-up view of same three week old patient diagnosed with left incomplete cleft lip and palate. Patient underwent surgery to repair the cleft lip. Patient is shown before surgery (left), and four months after surgery (right).

before after

Patient is shown before cleft lip repair (left) and four months following surgery (right).

before after

Close-up view of same patient before cleft lip repair (left) and four months following surgery (right).

Cleft Lip Surgery

How is cleft lip surgery performed?

Surgery to repair a cleft lip involves closing the separation between the two separated portions of the upper lip, restoring muscle function and making the two sides of the upper lip as symmetrical as possible. At the same time, flattening of the nose may be corrected. This surgery is generally performed when a child is approximately 3 months old. A second surgery may be required to further correct the nose or, occasionally, to further refine the appearance of the lip.

Sometimes the cleft can be bilateral (i.e., the lip is separated on both the right and left sides). This, too, is corrected with a surgical procedure performed when the child is approximately 3 months old. The bilateral lip is more likely to require a second operation on the lip and/or the nose.

To repair a cleft lip, the plastic surgeon will make an incision on either side of the cleft from the mouth into the nostril. The dark pink outer portion of the cleft lip is turned down and the muscle and the skin of the lip are pulled together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.

What can we expect following cleft lip surgery?

Your child may be restless for awhile after surgery, but medication can be prescribed to relieve any discomfort. To prevent your baby from rubbing the stitched area, elbow restraints may be necessary for a few weeks following surgery.

The stitches will either dissolve or be removed within approximately five days. Your surgeon will educate you on how to feed your child during the first few weeks after surgery.

What are the complications of cleft lip surgery?

When cleft lip surgery is performed by a qualified plastic surgeon with experience in repairing cleft lip or palate, the results can be quite positive. Yet, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

In cleft lip surgery, the most common complication is asymmetry, when one side of the lip and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.

It's also normal for the surgical scar to appear to get bigger and redder for a few weeks after surgery. This will gradually fade, although the scar will never totally disappear. In many children, however, it's barely noticeable because of the shadows formed by the nose and upper lip.

Cleft Palate Surgery

How is cleft palate surgery performed?

In some children, a cleft palate may involve only a small portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.

Prior to cleft palate surgery, the plastic surgeon works with the orthodontist to maximize the position of the hard palate with the use of an orthodontic device. The palate is then surgically closed; both the hard and the soft palate are closed during one operation.

To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.

Children with cleft palate problems usually also have problems with their ears. To help allow proper drainage and air circulation, the ear-nose-and-throat surgeon on the surgical team may recommend that a small plastic ventilation tube be inserted in the eardrum. Tubes are placed in both ears to minimize middle ear infections and possible hearing loss. This relatively minor operation may be done later or at the time of the cleft repair.

What can we expect following cleft palate surgery?

For a day or two following surgery, your child will probably feel some soreness and pain, which is eased by medication. During this period, you child will not eat or drink as much as usual -- so an intravenous line will be used to maintain fluid levels. To prevent your baby from rubbing the repaired area, elbow restraints may be used.

Your doctor will educate you on how to best feed your child during the first few weeks after surgery. It's crucial that you follow your doctor's advice on feeding to allow the palate to heal properly.

What are the complications of cleft palate surgery?

When cleft palate surgery is performed by an experienced, qualified plastic surgeon, the results can be quite positive. Yet, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.

Learn More

To learn more about reconstructive surgery treatment options for pediatric conditions at Cleveland Clinic, please call 216.444.4646 or 800.223.2273 ext. 44646.

What are vascular malformations?

A congenital vascular malformation is a kind of birthmark or congenital growth involving blood vessels. Sometimes the malformation presents nothing more than a cosmetic issue; other times, the malformation is deeper and can cause serious medical problems.

The Vascular Anomalies Center at Cleveland Clinic Children's offers precise diagnosis and innovative treatment for children with these lesions, which often are complex and difficult to manage.

Cleveland Clinic’s vascular anomalies team consists of an interventional radiologist, pediatric general surgeon, pediatric plastic surgeon, pediatric dermatologist, pediatric radiologist, vascular surgeon and pediatric hematologist. They consult with colleagues in otolaryngology, head and neck surgery, orthopaedics, urology or neurosurgery as needed.

There are a number of different sub-types of vascular malformations, depending on the predominant channel abnormality. These include:

  • Capillary malformations (portwine stains)
  • Lymphatic malformations (sponge-like collection of abnormal channels and cystic spaces that contain clear fluid)
  • Arteriovenous malformations (a connection between the veins and arteries)
  • Combined vascular malformations (involves two or more types of vessel abnormalities)

How are vascular malformations diagnosed and treated?

Correct diagnosis and treatment of vascular malformations are crucial.

The first step in evaluating patients involves a history, physical and diagnostic imaging. Cleveland Clinic radiologists use MRI and MR angiography for the diagnosis of vascular anomalies, and have pioneered the use of CT angiography to aid in diagnosis.

The most common vascular anomalies treated in the center are hemangiomas, venous and arteriovenous malformations, and lymphatic malformations. Some malformations, like capillary hemangiomas, go away on their own when the child is between 7 and 10 years. Others, like port-wine stains, should be treated because they may be associated with underlying disease.

If left untreated, port-wine stains can cause vascular blebs, or nodules, that can bleed significantly. Port-wine stains on the forehead or eyelids may be linked to Sturge-Weber Syndrome, a congenital neurological disorder. Infants with port-wine stains in those areas should be thoroughly evaluated. A series of laser treatments can begin as early as the first two weeks of life for small port-wine stains or hemangiomas.

Arteriovenous malformations (AVMs) generally appear during adolescence. Most AVMs extend into deep tissue, making surgery impossible, but require treatment.

Treatment for vascular malformations involves stopping or reducing the blood supply by injecting medication into the area. Large venous malformations require a series of injections.

For extensive malformations that are operable, like superficial arteriovenous malformations and benign lesions that interfere with function, surgical resection is usually performed. Prior to surgery, a combination of nonsurgical therapies may be used to decrease blood flow to the lesion or reduce its size.

BEFORE and AFTER images

Click through the following Cleveland Clinic patient images to see before and after surgical results.

Before

After

before after

Nine year old patient diagnosed with scleroderma and coup de sabre. Patient underwent surgeries to repair left forehead, nose, chin and right face. Patient is shown before surgeries (left), and after surgeries at age 18 (right).

before after

Right profile view of same patient. Patient was diagnosed with scleroderma and coup de sabre. Patient underwent surgeries to repair left forehead, nose, chin and right face. Patient is shown before surgeries (left), and after surgeries at age 18 (right).

before after

Left profile view of same patient. Patient was diagnosed with scleroderma and coup de sabre. Patient underwent surgeries to repair left forehead, nose, chin and right face. Patient is shown before surgeries (left), and after surgeries at age 18 (right).

Members of the Vascular Anomalies Center are conducting research and have established a database to monitor outcomes and identify the most effective treatments.

Learn More

To learn more about reconstructive surgery treatment options for pediatric conditions at Cleveland Clinic, please call us locally at 216.444.6900 or toll-free 800.223.2273 ext. 46900.

Schedule an Appointment Online

Call us for an Appointment

To schedule an appointment with a dermatologist or plastic surgeon, contact the Dermatology & Plastic Surgery Institute at 216.444.5725 (or toll-free 1.800.223.2273, ext. 45725).

Same-day Appointments

To arrange a same-day visit, call 216.444.7000

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

Cleveland Clinic Mobile Site