Cleft lip repair
For most infants with only a cleft lip, the defect can be repaired within the first several months of life. In certain cases, preoperative molding of the palate may help reduce the width of the cleft. Your child's plastic surgeon and pediatric dentist can determine if this approach is appropriate. The repair procedure uses the existing portions of the lip to close the cleft and improve the appearance of the nose.

Cleft palate repair
Repair of the cleft palate usually occurs between the ages of 10 to 14 months. This is a more complicated surgery, performed when the baby is bigger and better able to tolerate the procedure. Your child's physician will decide the exact timing of the surgery. This surgery fixes the roof of the mouth so that your child can eat and learn to talk normally.

Cleft alveolus repair
The final component of the palate to be closed is the gap in the gum tissue (alveolus) just behind the lip. This procedure is generally performed around seven to nine years of age, depending on the child’s dental development. This technique requires opening the mucous membranes and placing a bone graft into the defect. The bone graft is usually taken from the hip through a small incision.

Cleft rhinoplasty
Repair of the associated nasal deformity often begins at the time of lip repair. Newer techniques allow surgeons to reshape the tip of the nose earlier in life. Later, doctors may perform secondary procedures on both the tip and the bony framework.

Micrognathia reconstruction
Reconstruction of the deficient lower jaw may be done in several ways. Moving the chin may camouflage mild discrepancies. Cutting the bone and slowly and separating the ends to create new, healthy bone in the gap (“distraction”) can often moderate imbalance. Finally, severe cases may require inserting a bone graft from the rib or a flap of bone from the leg to restore facial symmetry.

Microtia repair
Rebuilding the deficient ear requires using either rib cartilage or synthetic material to recreate the ear structure. This procedure is usually done in two or more stages to create an ear that is similar in structure and projection to the opposite side.

Orthognathic (maxillofacial) surgery
Orthognathic surgery combines orthodontic treatment with surgery on one or both jaws to correct or establish a stable, functional balance between the teeth, bones, and soft tissues. The surgeries may involve a single jaw or both jaws (maxilla and mandible) and may be combined with other procedures, such as rhinoplasty (nose correction) or genioplasty (chin correction) to improve the general appearance of the face.

Otoplasty
Children with prominent ears often have special concerns regarding their appearance. Techniques to correct the exaggerated projection include scoring the ear framework to weaken the cartilage, holding the new position with sutures, and possibly removing excess cartilage from certain areas.

Pharyngeal surgery
For patients with velopharyngeal incompetence (VPI), the muscles of the soft palate and upper airway fail to adequately seal the nasal cavity from the remainder of the airway during speech. The result is a hypernasal sound quality that may require surgical correction. This procedure uses soft tissue from the back of the throat to reduce the size of the opening and facilitate closure during speech.

Positional plagiocephaly
For patients with skull deformities and no evidence of premature suture fusion, a plan of conservative management is recommended.  Treatment may involve mimimizing the time spent lying on the back of the head, physical therapy to correct any associated neck muscle imbalance, and cranial molding with an orthotic helmet.

Ptosis correction
Unequal appearance of the upper eyelids is immediately noticeable in both children and adults. Surgical correction involves tightening or reinforcing the insertion of the eyelid muscles, while minimizing the appearance of the scar.

Craniosynostosis repair
Specific treatment options for craniosynostosis depend on the patient’s age, overall health, extent of deformation, which sutures are involved, and parental input. Surgery is typically the recommended therapy. The procedure reduces pressure inside the head and corrects deformities of the face and skull. Surgery is optimally performed before the child is one year of age, while the bones are still soft and malleable. Treatment may be necessary at an earlier age, depending upon the severity of the abnormality.

The Mount Sinai Vascular Anomalies Program is a valuable resource for children and adults with vascular lesions, including hemangiomas and vascular malformations. Patients consult with a team of physicians and clinicians with expertise in treating simple and more complicated vascular lesions. The team approach helps patients reach their full potential. A carefully coordinated treatment plan can address these problems, often when the patients are quite young. Even in the most severe cases, our goal is to minimize the physical and psychological consequences of such anomalies, giving children access to a fuller, more satisfying life.

Hemangiomas
The treatment for hemangiomas depends upon their size, location and severity. Those with complications such as bleeding, feeding or breathing difficulties, growth disturbances, or vision impairment may require urgent medical or surgical intervention. Treatment may include medical management, laser therapy, or surgical removal.

Vascular malformations
The treatment for vascular malformations depends upon the type of the malformation. Laser therapy is usually effective for capillary malformations or port wine stains, which tend to be flat violet or red patches on the face. Arterial malformations often require embolization, which uses a clotting substance to block blood flow into the malformation, and surgical excision. Venous malformations may be treated by direct injection of a sclerosing (clotting) agent, combined with staged excision.