Physician-Scientists in the Division of Plastic and Maxillofacial Surgery are working diligently to put themselves out of business. They are committed to creating new knowledge about the underlying causes of congenital facial deformities while developing superior methods of treatment for the children who need them.

Research

Mark M. Urata, MD, DDS, head of the Division of Plastic and Maxillofacial Surgery, has recently received funding from the prestigious National Institutes of Health (NIH) to study the molecular mechanisms of cleft palate. This research is conducted in collaboration with Yang Chai, DDS, PH.D.at the Center for Craniofacial Molecular Biology of the USC School of Dentistry. The research is centered on defining the molecular chain reaction that must occur for a cleft palate to occur. Additionally, Dr. Urata received further funding from the NIH as part of a large multi-center study investigating possible facial patterns to autism. Dr. Urata is also the prinicipal investigator of the International Craniofacial Children’s Fund. This $5 million independently funded project at Childrens Hospital Los Angeles seeks to enable children with severe craniofacial abnormalities from medically-underserved countries to benefit from care they might otherwise be unable to receive. In addition,

Dr. Urata is co-principal investigator of the Teledentistry/eHealth Program designed to use state-of-the-art technology to deliver services to underserved population. The Division also has a robust clinical research program investigating the causes and treatment outcomes for cleft lip and palate, craniosynostosis, vascular anomalies and birthmarks, jaw surgery, craniomaxillofacial trauma, facial paralysis and ear reconstruction. The surgeons within the Division of Plastic and Maxillofacial Surgery and the care providers of all of the affiliated Care Centers publish routinely in the highest level of medical journals.

Innovations

Nasoalveolar molding (NAM) is a procedure done by our pediatric dentists and prosthodontists in the Division of Plastic and Maxillofacial Surgery prior to surgical repair for cleft lip and palate. Surgical repair alone cannot correct the multiple problems encountered with the deformities that result from clefts of the lip and palate.

A difficult challenge for the surgeon is the creation of an aesthetically acceptable correction of the middle part of the nose (called the deficient columella) and the deformity of the nasal cartilages. The NAM technique takes advantage of the malleability of immature cartilage of the nose and the ability to non-surgically construct the columella through the application of tissue expansion.

Pre-surgical infant molding (orthopedics) has been employed since the 1950s for correction of cleft lip and palate, but it does not take into account the deformities of the nasal cartilages and columella. By the addition of a nasal portion to the molding plate, we can now correct the nasal tip, the base on the affected side, as well as the position of the philtrum and columella.

Timing is critical. The ideal time to begin NAM is one to two weeks after birth. In a hospital setting, an impression is taken of the infant fully awake. A molding plate is then fabricated and inserted. The infant will wear the molding plate 24 hours a day for approximately four to six months. The molding plate causes no pain and is attached with small rubber bands taped to the face.

Adjustments to the molding plate/nasal portion are done weekly, or every other week, depending on the progress. Each adjustment is very small, but it starts to guide the baby's gums, lip, and nasal cavities as they grow.

At the conclusion of nasoalveolar molding (in unilateral cases, it is approximately four months and in bilateral cases, six months), the nasal cartilages, columella, philtrum and alveolar segments should be aligned to facilitate the surgical restoration of normal anatomic relations.

For more information on our nasoalveolar molding program ( NAM), please visit us here.