Jeffrey Hammoudeh, MD, DDS

BMP Utilization for Repair of Alveolar Clefts

Neonatal Distractions as an Alternative to Tracheostomy

Early Lip Repair Research: Cleft lip and palate is one of the most common congenital anomalies in the United States. The severity of cleft lip and palate can be vast, ranging from incomplete cleft lip and nasal deformities to complete bilateral wide cleft lip and palates. Traditionally throughout the United States, patients undergo repair of their cleft lip nasal deformities anywhere from 3-6 months of age. Patients with more severe clefts, consisting of wide unilateral cleft lips and bilateral cleft lips, may additionally undergo nasal alveolar molding, a non-surgical treatment before surgery which involves placement of a brace inside the nose and mouth for several months to help mold these structures. This typically delays the cleft lip repair until approximately 5-6 months of age. During Dr. Jeffrey Hammoudeh's early career at Children's Hospital Los Angeles, he was able to treat newborn babies with congenital ear deformities utilizing a technique called ear well. This technique takes advantage of a newborn baby’s elevated levels of estrogen and progesterone, hormones that allow surgeons to mold and form the ear cartilage (see figure 1). Dr. Hammoudeh has ultimately been able to apply these principles to the treatment of clefts, helping to pioneer routine neonatal cleft lip nasal repair. Over the last 4 years at Children's Hospital Los Angeles, Dr. Hammoudeh has served as the lead investigator, demonstrating efficacy and safety in repairing cleft lip nasal deformities at as early as 10 days of life.  This has provided a significant advantage to families interested in having their newborn undergo repair of the cleft nasal deformity shortly after birth, relieving a significant amount of family stress that can be associated with a protracted wait for repair. Additionally, Dr. Hammoudeh and his group have noted that the elevated levels of progesterone and estrogen which are critical for ear molding (figure 1) provide the same effect on the nasal cartilage. This allows the cartilage of the nose to undergo molding following repair while also capitalizing on the baby's elevated level of TGF beta, a hormone that allows for optimal wound healing. In this experience, they have operated on approximately 100 babies and have noted that repairing cleft lip and nasal deformities early in the first 2 weeks of life has allowed for superior results by minimizing scaring and helping the nose achieve optimal symmetry. Dr. Jeffrey Hammoudeh and Dr. William Magee are the only two craniofacial surgeons in the United States with this extensive experience that offer this breakthrough/cutting edge repair, allowing you and your child to return to optimal form and function shortly after birth. Both surgeons are available for consultation during pregnancy either via telemedicine or in person.