Craniofacial Orthodontics

What is craniofacial orthodontics?

Some conditions of the head and face affect how a child’s teeth, jaws and facial bones form. The position of their bite may be affected. Some children may have problems with chewing, speaking or breathing due to the position of their jaws.

Craniofacial orthodontics is a special field within orthodontics. It focuses on caring for dental and jaw issues related to conditions of the head and face, like cleft palate, craniosynostosis and many others.

How can craniofacial orthodontics help my child?

Throughout childhood, our pediatric dentists and craniofacial orthodontists check how your child’s teeth and jaws are developing. The orthodontists work with oral surgeons, craniofacial plastic surgeons and speech and language pathologists (SLPs) — and with you — to plan and provide treatments your child might need.

We coordinate dental and orthodontic needs with other treatments to get the best results. We also work with dentists and orthodontists in the community to fit the needs of patients who live outside the Seattle area.

Why choose Seattle Children's for care?

Very few orthodontists have special training or experience to treat children with craniofacial conditions. Our orthodontists are experienced in designing and carrying out treatments that affect the entire face, not just the jaws and bite.

They have years of experience in treating conditions from isolated cleft palate to complex syndromes that affect the shape of the face. Seattle Children’s has experts in every field your child needs. More than 50 specialists work together to diagnose and create a personalized plan of care for each child. This team approach sets us apart from other centers.

Services We Provide

Care for the teeth

Our pediatric dentists evaluate the health of your child's mouth, starting very early in life. When your child needs dental treatment, Seattle Children’s Dental Clinic may do the work, or our Craniofacial team may consult with your child’s own dentist.

Taking care of your child’s teeth is important, starting with their baby teeth. Some craniofacial conditions make children more likely to have dental problems. Based on your child’s condition, they may have teeth that are misshaped, crowded or missing. The hard coating on their teeth (enamel) may be weak, putting them at risk for cavities.

Healthy teeth are especially important for children with craniofacial conditions. The teeth support orthodontic appliances that may be part of your child’s treatment.

Fewer and more effective surgeries

In some cases, orthodontic work beforehand can reduce the amount of surgery your child needs. One example is nasoalveolar molding before surgery for those with cleft lip and palate. The goal of molding is to make the gap in the gums and lip smaller before your baby’s cleft lip surgery. This helps improve results for your child’s cleft lip repair. A better result with the first surgery can mean fewer surgeries later in childhood.

Orthodontic treatment can also prepare your child for surgery on their upper jaw (alveolar bone graft), if needed. Often an orthodontist will use an orthodontic appliance to better align the part of the jaw that holds teeth. The bone has a more typical shape when it is time for surgery.

Planning midface surgery and improving results

Surgery on the bones in the face is often part of the treatment for complex craniofacial conditions. These include Apert syndrome, Crouzon syndrome, craniofacial microsomia, Treacher Collins syndrome, Robin sequence and Saethre-Chotzen syndrome. Moving the bones in your child’s face can improve how they breathe, chew and look.

Weeks before the surgery, your child’s craniofacial orthodontist and surgeon work together to plan the procedure.

They use 3-D imaging and advanced software to build maps of your child’s face and skull. The technology helps the orthodontist figure out the best position for the cheekbones, nose and soft tissues of the face. This tells the craniofacial orthodontist and surgeon how much to move the jaw and facial bones — and in which directions. Moving the jaw improves the position of the teeth and bite.

Seeing an image of the expected results for their child helps many families decide about treatments.

Often, treatment to enlarge bones includes distraction osteogenesis after surgery. At regular visits to Seattle Children’s, your child’s craniofacial orthodontist and surgeon check the movement and growth of bones in your child’s face. They adjust the tension on the distractor or the direction of the pull to get the best result.

A. Before: Crouzon syndrome caused bones in the middle of this girl’s face to grow less than her lower jaw. This affected her breathing, chewing and appearance.

B. Planning: Using advanced imaging and software, the craniofacial orthodontist created a simulation of how the girl would look after treatment. The detailed plan guided the craniofacial surgeon in moving the cheekbones and jaw the right distances and directions.

C. After: After surgery and distraction osteogenesis, this girl’s face has more typical proportions. Her eyes are protected, her breathing is improved, and her teeth fit together better.

Correcting the bite and aligning teeth

Some craniofacial conditions affect the growth and position of your child’s jaws. Your child may need surgery on their upper jaw (Le Fort I procedure), lower jaw (mandible advancement) or both jaws (bimaxillary surgery) to help correct their bite.

Your child’s craniofacial orthodontist will use braces or appliances to put the teeth in the best position before surgery. After surgery on the jaw, your child will wear braces until their teeth settle into their new position. This takes at least 6 months. When treatment is complete, your child’s teeth and jaws will fit together better.

Treating speech problems

Some craniofacial conditions can make it difficult for your child to talk (speech problems). Cleft palate is an example.

Some children benefit from a custom-made speech appliance called an obturator (PDF) (Spanish). It looks like a dental retainer with a small bulb at the back. A dentist with special training makes the obturator to fit your child.

Treating a baby's airway

Babies born with Robin sequence have a small lower jaw, and their tongue is placed farther back than is typical. These features tend to block the baby’s airway. This can lead to problems with breathing and feeding. Many children with Robin sequence also have cleft palate.

One option to ease your baby’s breathing is an orthodontic airway plate (OAP). The OAP is like a retainer with an extension that holds your baby’s tongue in a safe position to keep their airway open. Your baby will wear their OAP at all times during treatment, usually 3 to 6 months. For many children, this improves their jaw position enough to avoid jaw surgery.

Scheduling an Appointment With the Craniofacial Center

• Contact the Craniofacial Center at 206-987-2208 for an appointment, a second opinion or more information.
• How to schedule an appointment at Seattle Children’s.
• If you already have an appointment, learn more about how to prepare.
• Learn about Craniofacial Center resources such as useful links, videos and recommended reading for you and your family.

Who is on the craniofacial orthodontics team?