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Surgical Procedures

Craniofacial Deformities and Surgery

Oklahoma City’s Leading Craniofacial Surgeons

Compassionate, Comprehensive, and Coordinated Care

At Profiles, cleft and craniofacial surgeon Dr. Paul Tiwana & Dr. Fabio Ritto treat the full spectrum of cleft and craniofacial disorders. We understand the unique needs and significant impact a craniofacial abnormality can have on your child. You can expect to receive compassionate, comprehensive, and coordinated care.

We see patients with a wide range of abnormality, from mild to severe, and a wide range of ages, from newborn to adult. We recognize that children and young adults with craniofacial anomalies have multiple needs that can be complex and varied. We also know these needs change as your child grows. That’s why we create individual treatment plans for our patients, tailored to each person and his or her specific needs.

Drs Tiwana & Ritto are affiliated with and co-lead the Cleft and Craniofacial Teams at the JW Keys Cleft and Craniofacial Clinic at the University of Oklahoma Health Sciences Center in Oklahoma City as well as the Mary K. Chapman Cleft and Craniofacial Clinic at the University of Tulsa in Tulsa, Oklahoma. These are the only 2 American Cleft Palate-Craniofacial Association approved teams in Oklahoma. We recognize that surgical plans need to be highly individualized. We look at your child’s full health history and make decisions that are based on age, how severe your child’s condition is, and other medical or health needs that may be present.

When your child has a congenital head or facial abnormality, the number of specialists who provide care and treatment can seem overwhelming. At our participating teams, we bring together experts from several specialties in one place. That means you won’t have to coordinate your child’s care. We take care of that for you.

Our multi-disciplinary team is composed of specialists representing:
• Cleft and Craniofacial Surgery
• Orthodontics
• Otolaryngology
• Pediatric Dentistry
• Speech and Language Pathology
• Audiology
• Neurosurgery
• Pediatrics

Distraction Osteogenesis

Distraction osteogenesis (DO) is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton. It was first used in 1903. In the 1950s, the Russian orthopedic surgeon, Dr. Gabriel Ilizarov slowly perfected the surgical and postoperative management of distraction osteogenesis treatment to correct deformities and repair defects of the arms and legs. His work went mostly unnoticed until he presented to the Western Medical Society in the mid-1960s.

Distraction osteogenesis was initially used to treat defects of the oral and facial region in 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided the oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.

Drs. Sullivan, Tiwana and Ritto uses distraction osteogenesis to treat selected deformities and defects of the oral and facial skeleton. If you have questions about distraction osteogenesis, please call our office and schedule an appointment with Drs. Sullivan, Tiwana or Ritto.

Frequently Asked Questions About Distraction Osteogenesis

What does the term distraction osteogenesis mean?
Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments.

Is the surgery for distraction osteogenesis more involved than “traditional surgery” for a similar procedure?
No. Distraction osteogenesis surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling.

Will my insurance company cover the cost of osteogenesis surgical procedure?
Most insurance companies will cover the cost of the osteogenesis surgical procedure provided that there is adequate and accurate documentation of the patient’s condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.

Is distraction osteogenesis painful?
Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly analogous to having braces tightened.

What are the benefits of distraction osteogenesis vs. traditional surgery for a similar condition?
Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments are involved.

What are the disadvantages of distraction osteogenesis?
Distraction osteogenesis requires the patient to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance. In some cases, a second minor office surgical procedure is necessary to remove the distraction appliance.

Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?
Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss that has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.

Does distraction osteogenesis leave scars on the face?
No. The entire surgery is performed within the mouth and the distraction devices used by Drs. Sullivan and Smith remain inside the mouth. There are no facial surgical incisions are made so no facial scars result.

Are there any age limitations for patients who can receive osteogenesis?
No. distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.


What Is Facesfirst?

Corrective jaw surgery treatment planning has three essential goals

  • Get the teeth in a normal bite
  • Orient the upper and lower jaws so they are spatially correct
  • Normalize the soft tissue expression, changing the spatial relationships of the jaw to get the most pleasing results possible. 

Our FacesFirst philosophy makes the expression of the face the highest priority.

The Difference?

Oral and maxillofacial surgeons tend to treat the x-ray that they are looking at rather than the face itself. For many of these surgeons, numbers drive treatment planning, rather than having a firm understanding of how the surgical movements of the upper and lower jaw impact the final form of the face. This is important not only looking at the front view, but also in the profile view.


FacesFirst is our unique philosophy. It places the emphasis on the final position of the upper jaw. The upper jaw, or maxilla, is what dictates the smile. It is incredibly important to place the upper incisors in their ideal position. The vertical position of the upper jaw will dictate how much tooth is shown at rest as well as smiling. Maximizing the width of the upper jaw fills out the smile line, making it far more aesthetic and eliminating areas where the cheek can be seen when one is smiling broadly. The smile is everything.


The upper jaw dictates the final position of the lower jaw and therefore the facial profile. With FacesFirst, the upper jaw determines the smile aesthetics and the lower jaw determines the profile aesthetics. Harmonious positioning is the key to the best possible aesthetic outcome.