Cleft & Craniofacial Surgery

Craniofacial surgery is a highly specialized field that corrects problems in the structure of your child’s skull, head, face, neck, or jaws. During craniofacial surgery, Dr. Urbinelli restores congenital and acquired problems in bones and/or soft tissues.

Dr. Urbinelli has been cultivated to be a leader in craniofacial surgery, as he was groomed by the top craniofacial surgeons in the US prior to moving to Portland, OR. He trained under the “giants” and pioneers in craniofacial surgery at NYU and then he completed an advanced fellowship at the University of Southern California, Children’s Hospital Los Angeles, one of the most busiest craniofacial and pediatric plastic surgery programs in North America.

What conditions does craniofacial surgery treat?

Dr. Urbinelli has extensive experience treating many craniofacial conditions. Some result from abnormal bone growth in the face or skull; others develop from differences of the face, jaws, skull, or ears, acquired due to inherited or spontaneous differences, or acquired post-traumatically or post-surgically.

The following are only a few examples of the conditions treated with craniofacial surgery:


A newborn’s skull is formed out of several discrete bones which are connected together loosely at sutures (fibrous connections) which allow the bones to grow and the head to expand as the brain grows. Craniosynostosis occurs when an infant’s skull bones fuse together too soon and hence can restrict brain growth. This condition can cause pressure inside the newborn’s brain and affect the neurodevelopment, IQ, shape/growth of skull, and facial bones.

Dr. Urbinelli is a leading expert in diagnosis, treatment, and care for all forms of craniosynostosis: single suture vs. multi-suture, sporadic vs. inherited/familial, syndromic vs nonsyndromic. His team will help you navigate this treatment journey and discuss with you and your family options for treatment planning/coordination.

His treatment options vary based on suture type, patient’s need, age, medical history and parent’s input. These include endoscopic approaches, spring assisted, distraction osteogenesis, open vs. minimally invasive cranial vault remodeling, frontal-orbital advancement, and total cranial vault remodeling.

Cleft lip and palate

Before birth, the right and left sides of the lip and the roof of the mouth grow together. In some babies, however, the tissues don’t close. A cleft lip occurs when the sides of the upper lip don’t meet. Babies have a cleft palate when the problem affects the roof of their mouth. Children can have a cleft lip, cleft palate, or both.

Craniofacial microsomia

Craniofacial microsomia, the second most common congenital difference after cleft lip and palate, occurs when one side of the face is smaller than the other. This condition most often affects the baby’s jaw and ear, but it may also affect the cheek, neck, and bones around the eyes.

Hemifacial atrophy (Parry-Romberg syndrome)

Hemifacial atrophy develops later in childhood or early adulthood. The condition appears gradually as the skin, soft tissues, cartilage, and underlying bone on one side of the face start to weaken and shrink.

Jaw conditions

Several craniofacial conditions cause problems with jaw development/growth and teeth closure (occlusion), which can cause an to an underdeveloped (smaller-than-normal), or a larger or asymmetric jaw Dr. Urbinelli frequently performs upper and lower jaw surgery for newborns, infants, pre-adolescents, adolescents, and young adults in need of jaw correction surgery. These procedures range from mandibular distraction, mandibular sagittal split osteotomies, Le Fort 1, 2 and 3 osteotomies, and other combinations.


Plagiocephaly is a common problem that causes a misshapen head. This condition can occur due to the baby’s position in the uterus or develop after birth when the baby sleeps in one position. In both cases, pressure on the soft skull causes one area of the head to flatten. Plagiocephaly most often occurs in premature infants.

Of all the conditions craniofacial surgeons treat, plagiocephaly is one that doesn’t typically require surgery. In most cases, Dr. Urbinelli recommends physical therapy or may prescribe a helmet that corrects the shape difference.

What procedures do craniofacial surgeons perform?

At PNW Plastic Surgery, Dr. Urbinelli specializes in the full scope of procedures needed to repair craniofacial conditions. He has extensive experience performing complex, open cranial vault remodeling for craniosynostosis. During this procedure, he often removes, reshapes, or replaces parts of the skull.

He’s also an expert in minimally invasive endoscopic dermoid excision and cranial surgery, as well as advanced techniques such as cranial vault distraction or posterior vault distraction osteogenesis (PVDO). During cranial vault distraction, Dr. Urbinelli uses a titanium device fixated across the skull (after a cut has been made) to lengthen and grow a skull bone and gently stretch the overly scalp skin to fit the new bone.

Distraction is a technique used for other bones, as well. For example, Dr. Urbinelli may perform segmental, subcranial Le Fort III or Le Fort 1 distraction to improve facial projection, cheek contour, eye coverage, or mandibular distraction to correct a small jaw for airway difficulties.

In addition to enlarging the jaw bone, Dr. Urbinelli does other types of jaw surgery (orthognathic surgery) to correct the jaw’s size, shape, or position.

Dr. Urbinelli is a national and international expert on distraction osteogenesis and orthognathic surgery including genioplasty. He has given national and international talks and presentations on these topics to physicians and other craniofacial surgeons and had literally written the textbook on Le Fort III distraction, genioplasty, facial aesthetics, proportions, facial fractures, mandibular distraction, and other topics (see textbook listings on his bio)

Some types of craniofacial surgery, such as cleft lip and palate repair, require Dr. Urbinelli’s plastic surgery skills to reshape and rebuild the tissues. Another type of procedure, called facial reanimation, lets children smile as Dr. Urbinelli restores paralyzed facial movements a nerve problem causes.

These are only a few of the many craniofacial procedures available at PNW Plastic Surgery. To learn the best treatment choice for your child, call the office or book an appointment online today.

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