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Craniofacial Program in Austin Experienced Care of Complex Craniofacial Syndromes in North Austin

The craniofacial team at Texas Children’s Hospital North Austin Campus has some of the most experienced craniofacial providers in the country. 

Our team has one of the largest single surgeon series of sub-cranial midface distraction procedures (Le Fort 3 Midface Distraction Advancement) with a safe track record and optimal results. Our surgeons introduced two new procedures to craniofacial surgery that are now internationally recognized - the Le Fort 2 distraction with simultaneous zygomatic repositioning (LF2ZR) for Apert and Pfeiffer syndromes, and the sub-cranial Counterclockwise Distraction Osteogenesis (C3DO) procedure for removing tracheostomies in patients with Treacher Collins syndrome or craniofacial microsomia. No other surgical team in the country has more experience in these innovative procedures. Finally, our surgeons are leading experts in staged surgical care of infants born with extremely complex craniosynostosis. We have described and follow a step-wise surgical protocol in the first year of an infant’s life that optimizes brain function. Our team of experts are able to offer experience and skill in all techniques that a child born with a complex craniofacial syndrome may require:

Neonatal strip craniectomy is a rare surgical procedure performed by a pediatric neurosurgeon and a craniofacial surgeon. We recommend this technique in cases of very severe syndromic craniosynostosis involving multiple suture fusion, such as Pfeiffer syndrome. 

  • Only performed in cases where the brain is under pressure immediately after birth
    • Done in the first few weeks to allow the infants brain to expand
    • Allows bone to form in the skull so that future cranial surgeries will be successful

Our senior surgeon and craniofacial orthodontist both trained with Dr. Joseph McCarthy, the innovator of mandible distraction osteogenesis (MDO). With decades of experience our craniofacial surgeons have learned when MDO is indicated and when it should be avoided. Our philosophy is to perform MDO at the correct time and for the right reason to avoid multiple treatments. We are careful to avoid pressure on the mandible joints to avoid long term problems that can occur after MDO.

  • Involves using a special piezoelectric saw to cut the bone of the lower jaw through a small incision.
  • Care is taken to avoid damage to the nerves and teeth within the lower jaw
  • A distraction device is applied that is either under the skin (internal MDO) or is on the outside of the skin and attached through small pins (external MDO)
  • The devices are used to slowly open the gap in the bone at 1mm/day
  • Turning of the device starts approximately 5 days after surgery and continues at 1mm/day for 2 to 3 weeks
  • The device is turned by the caregivers at home and is easy to learn
  • The slow turning creates bone in the opening gap to make the lower jaw longer
  • The devices are removed during a day surgery 2-3 months later
  • MDO is typically used to improve a child’s airway to avoid or remove a tracheostomy
  • Indications for MDO include:

Posterior cranial vault distraction (PVDO) is used in syndromic or multiple suture craniosynostosis to expand the back of an infant’s skull. Our team uses this distraction osteogenesis technique in situations where the growing brain requires more space, but the child is too young for surgery on the front of the skull (Fronto-orbital Advancement). 

  • PVDO is performed by a pediatric neurosurgeon and craniofacial surgeon at 4-9 months of age
  • Only the most severe cases of craniosynostosis need PVDO
  • Through a zig-zag scar in the scalp, the back of the skull is separated from the front with a thin cut in the bone
  • Small distraction devices are placed across the bone separation line with activation posts that exit through the skin
  • The scalp is then closed and the surgery is over
  • The day after surgery, the devices are turned at 1-2 mm/day for 2-3 weeks
  • The devices open the separation so that the back of the skull slowly moves backwards and expands the volume of the skull.
  • When the bone is in the correct position, the device arms are removed in clinic and bone is allowed to form in the separation gap for 4-6 weeks. 
  • The devices under the skin are removed during a day surgery procedure after bone healing
  • Performed through the same coronal incision as other open cranial remodeling surgeries 
  • For non-syndromic craniosynostosis is usually performed from 10-12 months of age
  • For syndromic craniosynostosis is best performed older, closer to 2 years of age
  • Involves a pediatric neurosurgeon and craniofacial surgeon working together
  • The bone of the forehead and brow bones are removed and reshaped
  • The bones are put back in a position with better shape and more space for the brain
  • Plastic plates and screws that dissolve after 9 months are used to hold the bone in place
  • Patients spend one night in the ICU and 3-5 days in the hospital
  • Performed through the same scalp scar as other cranial surgeries
  • Less common than fronto-orbital advancement
  • Used for severe syndromic craniosynostosis to improve airway, expand skull and protect eyes at the same time
  • Performed at 1 to 4 years of age
  • Can be needed by older patients if face and forehead are equally affected
  • Involves a pediatric neurosurgeon and craniofacial surgeon working together
  • The bones of the forehead and the upper face are separated so they move together
  • An external skull mounted halo distraction device is placed at the time of surgery
  • Patients spend 2 nights in the ICU and 5-7 days in the hospital
  • The distraction device is turned after surgery for two weeks to bring the forehead and face forward
  • The device is left in place for two months then removed as a day surgery
  • Le Fort 2 distraction with simultaneous zygomatic repositioning (LF2ZR) is a midface surgery our team first described to treat craniofacial conditions where parts of the face have grown differently than other parts.
  • One of our surgeons and our craniofacial orthodontist in North Austin first introduced this innovative surgical technique and have published research describing its success
  • No other center has more surgical experience in performing the procedure
  • LF2ZR is used for children age 7-11 years old with Pfeiffer syndrome or Apert syndrome, but can also be done on older patients and for other conditions such as Achondroplasia.
  • Treats symptoms and appearance better than the traditional approach (Le Fort III advancement). 
  • Segmental subcranial distraction makes the proportions of the face more balanced in children with Apert or Pfeiffer syndrome. As a result:
    • The length of your child’s nose is increased
    • There is a natural and protective curve to their face
    • Their eyes are protected by the cheek bones and are more level
    • Your child can breathe more easily
    • Patients say they like how their face looks after LF2ZR surgery
  • This powerful technique can also be used to treat patients with Achondroplasia who have airway obstruction

Learn more about LF2ZR here.

  • Members of our team were the first to describe the C3DO procedure to remove the need for a breathing tube in the windpipe (tracheostomy) in children born with Treacher Collins syndrome or other conditions such as craniofacial microsomia.
  • No other surgeon or orthodontist in the world has the same experience with this technique. Many patients who benefit from C3DO have undergone previous more traditional surgeries without success. Our senior surgeon has performed more than 25 cases from around the country with a greater than 90% success in removing the tracheostomy. This surgery requires coordinated care from our dedicated team of craniofacial surgeons, airway specialists and our craniofacial orthodontist. Surgeons around the world are adopting our approach.
  • C3DO works when traditional surgeries do not because it corrects the rotation deformity of both jaws at the same time. This powerful rotation movement opens up the entire upper airway from the back of the nose down to the vocal cords. This rotation surgery opens your child’s airway and allows them to breath without the tracheostomy.

Learn more about C3DO

  • Le Fort 3 midface advancement is a powerful technique used to treat the lack of growth of the upper jaw and cheeks in conditions such as Crouzon syndrome. 
  • In patients with Apert or Pfeiffer syndrome, we usually recommend a segmental Le Fort 3 procedure known as LF2ZR. 
  • Our surgeons have one of the largest experiences with Le Fort 3 midface advancement surgeries in the country with consistently safe outcomes. The Le Fort 3 advancement brings the bones of the cheek and entire upper jaw forward at the same time. 
  • This procedure helps children breathe better and makes up for the lack of growth in the upper jaw. The cheekbone movement protects their eyes patients and families report that the face looks better after Le Fort 3 advancement
  • We recommend advancing the face using distraction osteogenesis, a technique that slowly stretches a cut made in the bone during surgery using a special device that is slowly turned in the weeks after surgery. For the Le Fort 3 advancement we recommend an external “halo” based device.
  • The surgery is usually done when your child is 7 to 11 years old. If breathing is a problem, we may recommend doing it as young as 3 years old.

When a patient with a complex craniofacial syndrome approaches the age when their bones stop growing, they often require carefully coordinated orthodontics and surgery to line up their jaws and teeth. Our team in North Austin has some of the most experienced specialists in the country to treat these conditions. Our surgeons and orthodontist work closely together, and you will usually see both specialists at the same time. To learn more about jaw deformities requiring orthodontics and surgical correction click here.

  • Some children are born without the joint that lets them open and close their lower jaw. This joint is the ‘temporomandibular joint” or “TMJ”. 
  • Other children are born with the TMJ fused, called “TMJ ankylosis”. 
  • Treatment of these two conditions is very complex, but our specialists can describe a treatment plan to help reconstruct the TMJ to allow opening and closing of the lower jaw.
  • If your child is young, these treatments may use bone and cartilage taken from one of your child’s ribs through a small incision to remake the joint. 
  • In young adults with TMJ ankylosis, we may recommend using man-made titanium joints that are custom built. These are similar to the titanium joints used to reconstruct knee or hip joints in older people. 

CRANIOFACIAL SURGICAL CARE TAILORED TO THE NEEDS OF YOUR CHILD

We recognize that every child is unique and therefore deserves a dedicated treatment plan. Our experienced team will determine what procedures your child will need based on their anatomy and past surgical history. We do not treat based on syndrome names, but by the particular presentation of the patient. Two patients may have been diagnosed with the same syndrome, but follow two different treatment pathways depending on their severity and anatomy. 

SUPPORTING CHILDREN WITH COMPLEX CRANIOFACIAL SYNDROMES EVERY STEP OF THE WAY

We recognize the challenges that children with craniofacial syndromes bravely face and the demands placed on their families as they strive to meet their child’s needs. Our team will work with you to support your child and your family in any way we can. Our team of specialists are trained to provide safe and high quality clinical treatments, but we also understand the importance of holistic support during your emotional journey of care. Our team includes Child Life specialists who are experienced in supporting your child emotionally to decrease their stress in the clinic, when waiting for surgery, and while in hospital. We also have child psychologists to help adolescents and teenagers have a voice in understanding their challenges and ways to cope with them. Our entire team in North Austin is dedicated to recognizing the unique needs of your child with a craniofacial syndrome and to walk beside them in support as they undergo their treatments.