Henry K. Kawamoto, MD, DDS
Reza Jarrahy, M.D.
James Bradley M.D.
The Craniofacial Center treats congenital and aquired deformities of the craniofacial skeleton and soft tissues. These disorders include craniosynostosis, Aperts Syndrome, orbital hypertelorism, temporomandibular joint (TMJ), disorders Crouzons Syndrome, Treacher-Collins Syndrome, facial clefts, dental-facial deformities and facial tumors. We also perform post-traumatic reconstruction of acquired deformities due to trauma or injury. The team examines patients and discusses treatment plans weekly, allowing patients to see most or all related specialists in a single visit. The team consists of craniofacial surgeons, neurosurgeons, otolaryngologists, orthodontists, oral surgeons, psychiatrists, dentists, ophthalmologists, pediatricians, geneticists, speech pathologists and social workers. Referring specialists are informed regularly of patients' treatment plan and options.
Craniofacial outpatients are seen in the Plastic & Reconstructive Surgery Office in Suite 465 in the 200 Medical Plaza Office Building on the UCLA campus across from the UCLA Center for Health Sciences in Westwood, CA.
Surgery is performed in the UCLA Hospital operating room in the UCLA Center for Health Sciences or in the UCLA Surgery Center on the 6th floor of the 200 Medical Plaza Office Building.
Note: questions regarding the appropriateness of referrals or patient care related issues will be referred to the physician.
The following represents general treatment protocols for patients with cleft lip and palate as well as other craniofacial disorders. These are not meant to be specific guidelines and in fact in many cases we alter these protocols when it is in the best interest of the patient or the family.
Treatment Protocol: Cleft Lip and Palate
Clinic visit for 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 of course evaluation and planning for surgery. Orthodontic preparation is begun at this time.
Cleft lip repair
Between 3 and 12 months
Construction of further dental splints if indicated, one or more hearing/ear evaluations and speech evaluation
One year of Age
Cleft palate repair and placement of ear tubes, if necessary
Between One and Five Years of Age
Periodic (e.g. annual or bi-annual) clinic evaluation of speech (if abnormal, speech therapy is started through school or clinic), hearing, dentition and social/emotional development.
Occasionally, palate and lip revision surgery is required and is performed 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 childs deformity prior to beginning school.
Between Five and Nine Years of Age
Cleft patients typically require orthodontic preparation for surgical bone graft of the cleft in the palate before permanent teeth erupt. This is performed during this period. When adequately prepared, the bone graft procedure is performed to move bone from the hip to the bone hole in the palate. Also the speech assessment is continued during this time.
Between Nine and 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 nose surgery is accomplished if neccessary.
Treatment Protocol: Craniofacial Disorders
(There are many different types of craniofacial anomalies and therefore this protocol is meant to be a general outline only.)
Clinic visit for general pediatric evaluation with emphasis on feeding difficluties, hearing problems, genetic counseling, dental evaluation, eye evaluation and possible construction of dental splints or prostheses, emotional support services and of course evaluation and planning for surgery. Xrays and CAT scans are typically performed to define the exact nature of the disorder.
At Three to Six Months of Age
Helmet therapy is begun to remodel the skull for babies with crooked skulls or plagiocephaly.
Between 6 and 24 months of Age
Surgery may be indicated to remold and reshape the skull or upper face. This is performed as a joint procedure between the craniofacial surgeon and the neurosurgeon usually at 6-12 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 childs advantage in healing and remodeling bone.
Between Two and 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 team routinely uses distraction instruments placed totally inside the mouth and avoids scars on the cheek whenever possible.
For children with impaired facial growth (typically seen in Aperts, Crouzons 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 the speech, teeth, eyes, and ears are performed on a annual or bi-annual basis as needed. Orthodontic treatment is begun if necessary leading toward final nasal and jaw surgery late in the teenage years.