For over 25 years Dr. Toth has been committed to taking care of children with severe craniofacial deformities. He strongly believes the best cosmetic surgeon is the one who also deals with challenging reconstructive problems. In 1984 Dr. Toth founded the Craniofacial Panel at Children’s Hospital Oakland and continues this commitment by operating five days a month on children with severe facial deformities. He has been a pioneer in the procedure of midfacial bone distraction, a procedure that can change a child’s appearance by slowly advancing forward the bones and soft tissue of the face.
Cleft Lip & Palate
Cleft lip and palate are congenital deformities resulting in a gap in the upper lip and/or the roof of the mouth. This deformity occurs during the first trimester of pregnancy. The skill and experience of the plastic surgeon is critical to maximizing aesthetic and functional outcomes, while also minimizing surgery, hospital stay and long-term costs. Approximately one in 500 children is born with a cleft lip and/or cleft palate. Frequently these children have feeding, dental, facial growth, speech, and sleep or breathing difficulties. Surgical treatment is carried out in stages over a series of years to be timed with the patient’s facial growth. Dr. Toth established the Craniofacial Panel at Children’s Hospital Oakland because he understands that team care is important to the management of a child born with a cleft. Dr. Toth does the surgical repair of the lip, repair of the palate, and correction of the nasal deformity.
A cleft of the lip may be unilateral (one side) or bilateral both sides), complete or incomplete. The more complete the cleft, the greater the amount of tissue is absent. The goals of cleft lip repair include re-establishment of muscle continuity and re-creation of the normal landmarks of a lip. Dr. Toth prefers to repair the cleft of the lip at approximately three to four months of age when the risks of surgery are minimized, and allows for the patient to be discharged home the day after surgery. Immediately following surgery these babies are then able to feed easily, resume breast feeding in the recovery room, gain weight quickly, and return to their families with minimal disruption.
A cleft of the palate, like the cleft of the lip, may be unilateral or bilateral, involve the soft palate only, soft and hard palate, and/or extend through the alveolus where teeth will eventually erupt. The goals of cleft palate repair include re-establishment of muscle continuity in the soft palate, and re-approximation of the palate lining across the cleft. We prefer to repair the cleft of the palate at around nine to 12 months of age so that when speech development occurs the palate is anatomically in its proper position. When the cleft extends through the gum line a bone graft may be required. This is generally done at between the ages of six to eight years, when the baby teeth are falling out and when the permanent teeth are coming in. This allows the orthodontist to then move the child’s teeth into the site of the previous cleft.
Cleft Nasal Deformity
Children born with a cleft of the lip always have some degree of nasal deformity. The affected side of the nose is widened and flattened due to displacement of the nasal cartilages. The goals of cleft nasal surgery are to re-establish normal nasal tip projection, realign the nose, and reposition the malaligned nasal base. In general, we prefer to do this procedure at the time of facial skeletal maturity, at approximately 14 years of age.
Craniosynostosis is a condition in which one or more of the growth plates in a child’s skull fuse prematurely resulting in an abnormal growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures resulting in deformity. Sometimes this abnormal growth pattern results in increased intracranial pressure, leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development. Craniosynostosis occurs in one in 2000 births. Craniosynostosis can also be a part of a syndrome in 15 to 40% of the patients, but it usually occurs as an isolated condition.
Dr. Toth works closely with Dr. Peter Sun, the chief of Neurosurgery at Oakland-Children’s hospital and together as a surgical team they release the fused suture and correct the skull deformity. This procedure generally takes place during the first 6 months of life. These children are then followed by the Craniofacial Team at Children’s hospital where your child is followed by a multispecialty group of doctors. Dr. Toth is the director of the Craniofacial Team.