Yale Craniofacial Program

At the Yale Craniofacial Program, our faculty members are dedicated to improving the health, well-being, and appearance of children with craniofacial defects. Their clinical and translational research has helped create new diagnostic and treatment strategies and advanced surgical techniques for children all over the United States and around the world. 

Our faculty members at the Yale Craniofacial Program are internationally recognized for providing the highest-level of coordinated management and comprehensive care for children with the most complex congenital, traumatic, tumor, and vascular anomalies of the head and neck.  

At the Yale Craniofacial Program, treatments for Apert syndrome involve interdisciplinary specialists to help children through every step of the process. Children benefit from multiple surgeries from infancy through early adulthood; in general, the earlier they begin treatment, the better the outcome. 


Treatments of Apert syndrome may include: 

  • Surgery to protect the cornea and vision 
  • Intubation to open upper airway during the neonatal period 
  • A tracheotomy may be needed for severe cases of sleep apnea 
  • Ventilation tubes for chronic earaches 
  • Cranial surgery to open prematurely fused sutures and to reshape the skull and relieve increasing pressure on the brain 
  • Orbital surgery to enlarge the eye sockets to reduce bulging of the eyes 
  • Nasal surgery to open nasal passageways 
  • Midfacial surgery to improve appearance of the midface, expand the inferior orbit to expand the airways, and to establish a normal dentoskeletal relationship
  • Mandibular, or jaw, surgery for both appearance and function
  • Surgical separation of fingers and toes 

During the planning stage, we use the most advanced 3D imaging techniques for a complete understanding of the child’s specific condition, and how the child’s soft and bony tissues are affected. By gathering accurate data about the child’s craniofacial differences, we can: 

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery 
  • Follow and monitor the child’s condition during the post-surgical healing process 
  • Monitor the child’s long-term development 

At the Yale Craniofacial Program, children receive care from some of the top surgeons and specialists in the world.

We have the specialized training to use nasoalveolar molding before cleft lip and palate surgery, a technique that may mean fewer surgeries.

A cleft lip is generally repaired between three and six months old, but a child may need multiple surgeries to achieve optimal improvement in appearance and in oral function.

During the planning stage of surgery, we use the most advanced 3D imaging techniques for a complete understanding of the child’s specific condition. By gathering accurate data, we can:
  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

The treatment of cleft palate is more complex than the treatment for cleft lip. Children who have cleft palate can also have feeding difficulties, speech issues, earaches, hearing loss, and dental issues. Repair for cleft palate generally begins at 9 to 12 months old. Ear tubes, if needed, are placed at the same time as the palate surgery. In order to achieve the best aesthetic outcome and oral function, the child may need several surgeries. Additional surgeries may be recommended in the future. Such procedures include pharyngeal flap, alveolar bone graft, rhinoplasty, and/or upper jaw surgery.

If a child does need surgery, the best results are obtained when surgical treatment is performed between 3 and 6 months old. In most cases, only one surgery will be needed. Children generally recover from surgery much more quickly than adults do. In fact, most children feel only a little pain from craniosynostosis surgery, often needing no more than acetaminophen for a few days.

Our faculty at the Yale Craniofacial Program offers surgical treatment for craniosynostosis with specialists from 18 clinical services. With some of the top surgeons in the world, patients can expect the latest breakthroughs in treatment and among the best care they can receive.

By gathering accurate data about the child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

Crouzon syndrome is complex and can require several disciplines, such as craniofacial surgery, neurosurgery, oral surgery, orthodontia, and ophthalmology.

Depending on the severity of the syndrome, the surgeries will take place in steps, generally beginning with surgery to stop the cranial sutures from fusing.

During the planning stage, we use the most advanced 3D imaging techniques for a complete understanding of the child’s specific condition and how the child’s soft and bony tissues are affected. By gathering accurate data about the child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

If a CT scan shows that the skull is not growing fast enough for the brain expansion, surgical treatment will be required to enlarge the skull. In most cases, the child remains in the hospital for only three to four days.

The child may need additional surgeries to correct the jaw and eye sockets, and orthodontics to straighten the teeth and to keep the mouth from crowding.

By gathering accurate data, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development
  • Surgery for unilateral facial paralysis

In some cases, the palsy will resolve on its own. In other cases, surgery may be required.

When facial paralysis is on one side of the child’s face, one procedure that can be used is cross-facial nerve grafting. This procedure involves a graft from the unaffected side to the affected side. A donor nerve is used from the child’s leg. In a later surgery, a donor muscle is also taken from the leg and is transplanted into the face and connected to the transplanted nerve. 



If the child has paralysis on both sides of their face, a donor muscle from the leg is transplanted to one side at a time, using a nerve that assists with chewing rather than harvesting nerves from the leg. The second transplant can generally be done a few months after the first transplant surgery. An incision along the hairline is used because it usually heals well into a thin, flat scar.

With top surgeons and specialists from 18 clinical services within Yale, our craniofacial faculty offers comprehensive treatment for vascular anomalies.

The infantile hemangioma generally continues to enlarge for 8 to 12 months before beginning to shrink on its own. As it resolves, the bright red color will begin to turn grey and white. The lump will soften and then shrink. Some hemangiomas can take up to seven years before they are fully resolved. Up to 70 percent of hemangiomas leave no visible mark.

In the remaining cases, hemangiomas can leave deformities, including extra skin, a change in skin texture, fatty scar tissue, and residual vessels. Such deformities are extremely common in the areas of the nose, lips, and cheeks. 

There are different treatment options to limit the growth of the tumor and speed the time it takes to resolve. There are generally four ways to interrupt the growth of hemangiomas:

  • Laser treatment uses laser lights to restrict the blood flow to the tumor by targeting the abnormal blood vessels that cause the hemangiomas. Often the hemangioma will heal, but within a few weeks, it tends to grow back.
  • Steroids, which are given orally, may help accelerate shrinkage of the tumor. In rapidly growing tumors, sometimes, the steroid is applied topically or injected into the tumor site.
  • Surgery is used to remove or reduce the hemangioma (or to revise the deformity left from a hemangioma once it has resolved).

By gathering accurate data, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

In some cases, urgent treatment for hemangiomas is needed. Some of these vascular malformations are located around the eyes or in the airway near the vocal chords, which can be dangerous. Hemangiomas near the eye can cause permanent lazy eye and cornea distortion. Hemangiomas that constrict the airway can block the child from breathing. At times, hemangiomas can grow in the liver, causing stress to the heart. 



Another place of growth that may require surgery is when the hemangioma occurs in the salivary gland in front of the ear, because it can cause hearing loss. A tumor located on the lower back and pelvis may cause compression on the spinal cord and may also require surgery.

Some ulcerated hemangiomas may need medical attention, especially when they occur in the genital area where stool and urine irritate the open wound or if they bleed heavily from an open artery.

Hemifacial microsomia is a complex, three-dimensional deformity requiring interdisciplinary treatment.

Actual treatment for hemifacial microsomia is determined by the specific craniofacial abnormalities of each child.

Often treatment includes:

  • Plastic surgery: to repair ear and facial malformations
  • Craniofacial surgery: to create improved facial symmetry, to realign the lower and upper jaw, to establish normal joint function, to add soft tissue where needed
  • Oral surgery: to align the teeth of the upper and lower jaws

If the child’s hearing is impaired, we will evaluate the extent of loss and provide appropriate treatment.

Ear reconstruction generally begins at about five to six years of age and involves three to four surgeries.

By gathering accurate data about a child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

By 5 or 6 years old, a CAT scan can be done of the middle ear to find out the level of its development. This scan will help determine if the child is a candidate for surgery to improve their hearing. 



Treatment options for auricular reconstruction include:

  • Rib Cartilage Graft Reconstruction: This technique uses cartilage from the child’s rib cage. This ensures that the reconstructed ear grows with the child. Generally, this surgery is performed when the child is 8 years old – around the time the child has enough donor tissue in the rib cage. 
  • Prosthetic Framework Method: In this procedure, surgeons use a polyethylene plastic implant to reconstruct the ear. This surgery can start at age 3 as an outpatient without hospitalization. A porous framework in the implant allows the child's own tissue to grow into the material and their own tissue flap. A new ear is constructed in a single surgery. Sometimes a follow-up surgery is required for minor adjustments. 
  • Ear Prosthesis: In cases where other treatments aren’t successful or possible, a prosthetic ear is custom made for the child to mirror the unaffected ear. They are typically made of silicone, which is colored to match the child's skin and can be attached using an adhesive or titanium screws.

By gathering accurate data, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery 
  • Follow and monitor the child’s condition during the post-surgical healing process 
  • Monitor the child’s long-term development

Because the sequence affects different areas, such as the jaw, palate, breathing, feeding, and hearing, a team of interdisciplinary specialists is needed to offer the best care for the child.

Before anything else, the baby must be able to breathe. If keeping the baby on their belly isn’t enough to keep the airways open, the child might need a small tube placed though the nose into the upper airway. If this treatment does not work, the lower jaw may need to be enlarged to allow the tongue to come into the mouth. If the breathing obstruction is severe enough, a tracheotomy may be used. Once the baby can breathe, generally feeding is improved.

Around 12 to 18 months old, the cleft palate will need to be repaired. Because children with cleft palate tend to get a fluid buildup behind the eardrum, small plastic tubes are often inserted into the eardrum at the time of the surgery for clefting.

By gathering accurate data, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery 
  • Follow and monitor the child’s condition during the post-surgical healing process 
  • Monitor the child’s long-term development

Because most children with Saethre-Chotzen have craniosynostosis, the treatment process is very much the same as the process for craniosynostosis.

Other treatments for Saethre-Chotzen syndrome include surgery for cleft palate or webbed fingers, as they can be features of the syndrome.

If the child has feeding problem or hearing loss, the process is much the same as a child with cleft palate.

By gathering accurate data about the child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

If a child has Pierre Robin Sequence because of Stickler syndrome, they will need a comprehensive team of specialists.

During the planning stage, we use the most advanced 3D imaging techniques for a complete understanding of the child’s specific condition and how the child’s soft and bony tissues are affected. By gathering accurate data about the child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

First and foremost, the child must be able to breathe. If keeping the baby on its belly is not enough to keep the airways open, they might need a small tube placed though the nose into the upper airway. If this treatment does not work, the lower jaw may need to be enlarged to allow the tongue to come into the mouth. If the breathing obstruction is severe enough, a tracheotomy may be used. Once the baby can breathe, generally feeding is improved.

At around 12 to 18 months old, surgery to close the cleft palate will be necessary. At the same time, if needed, tubes will be inserted into the eardrum to help drain excess fluid often associated with cleft palate.

The child should be evaluated regularly for any signs of vision problems, such as cataracts and retinal detachment. The child may also need surgery to correct clubfoot. Later in life, hypermobility of joints can lead to early arthritis, which might require pain management, avoidance of high-impact physical activity, and joint replacement.

Depending on the severity of Treacher Collins, the child may need more than one surgical treatment. Patients are cared for by leading-edge surgeons in the country who have special interests in techniques and research for craniofacial growth and development, as well as cosmetic surgery and quality of life issues related to birth defects and trauma.

During the planning stage, we use the most advanced 3D imaging techniques for a complete understanding of the child’s specific condition and how the child’s soft and bony tissues are affected. By gathering accurate data about the child’s craniofacial differences, we can:

  • Simulate the outcome of proposed surgical plans and adjust any discrepancies before surgery
  • Follow and monitor the child’s condition during the post-surgical healing process
  • Monitor the child’s long-term development

Some treatments might include:

  • Eyes: surgery to correct the notch or sagging on the eyes
  • Ears: surgery to improve the aesthetic appearance of the ears
  • Hearing: hearing tests and hearing aids to improve hearing and speech development
  • Hands: surgery to improve hand function
  • Jaw: treatments to lengthen the jaw
  • Cleft palate: surgery to repair cleft palate
  • Cheekbones: surgery to rebuild cheekbones

The age at which surgical treatment begins will vary. Surgery to rebuild the cheekbones might begin before the age of five, while ear reconstruction might begin around age six.

Most children born with van der Woude syndrome have inherited it from one of the parents.

Children with van der Woude syndrome have pits or mounds of tissue in the lower lip, cleft lip, cleft palate, or both a cleft lip and cleft palate. It is possible to have only one of these features, or the child can have all or any combination of them. They may require surgical treatment.

The treatment of velopharyngeal insufficiency usually requires surgery, such as a tonsillectomy, pharyngeal flap, sphincter pharyngoplasy, or posterior pharyngeal wall implant. The implant can be either temporary or permanent.

The Yale Craniofacial Program is experienced at treating children with 22q11.2 deletion syndrome. We offer patients superlative care from some of the top specialists in the world.

The approach to treatment for 22q11.2 deletion syndrome varies depending on how the syndrome manifests in the child. Some common problems and treatments are listed below.

Cleft palate and earaches:
Surgical repair of a cleft palate will generally begin around age one. At that time, tubes will be placed in the eardrum if the child is prone to fluid buildup in the ear.

Feeding and breathing:
Cleft palate can cause difficulty in breathing and eating for the infant. They might need a small tube placed though the nose into the upper airway. Generally, when the child can breathe better, feeding improves.

Heart:
If the baby has signs of a heart problem, an ultrasound can help see the extent of those problems.

Kidneys:
Some children with 22q11.2 deletion syndrome can have abnormally formed kidneys. An ultrasound can help determine if there are any problems with them.

Meet Our Craniofacial Program Faculty
John A. Persing, MD

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