Pediatrics Articles from Ochsner Health Experts

Expanding the Reach of Cleft & Craniofacial Care with Michael Friel, MD

According to the Centers for Disease Control and Prevention, around 1 in 1,050 babies born in the U.S. have a cleft lip with or without a cleft palate, and around 1 in 1,600 have a cleft palate alone. For one Ochsner Health clinician, building a leading center to care for children with these congenital differences is personal. 

Michael Friel, MD, director of pediatric plastic and craniofacial surgery at the Ochsner Children’s Hospital, was born with a bilateral cleft lip and palate. Years of repair surgeries, orthodontics and bone grafting followed. Seeing the skill and humility of the pediatric plastic surgeons and other clinicians who cared for him inspired Dr. Friel to pursue a medical career. Now, he finds himself in the role of the professionals he once admired, and he brings a unique perspective to the care of his patients. 

“It’s quite emotional to perform a primary cleft lip repair,” Dr. Friel said. “Some parents have caught me tearing up when I talk with them after surgery. This repair can change a child’s life for 70 to 80 years. Certainly, it’s a little lagniappe to have walked the road of a patient with a cleft lip and palate. I don’t have to read about it to tell parents what it will be like. I can tell them what my life is like.” 

Robust Growth Across an Integrated Network 

Before Dr. Friel arrived in 2017, the cleft and craniofacial program treated a small number of infants each year. Now, the program serves hundreds of patients annually, including some from as far away as Georgia and North Texas. Seamless coordination across the Ochsner system delivers care beyond New Orleans to patients throughout Louisiana and Mississippi, including in Baton Rouge, Slidell, Lafayette, Jefferson, Covington and Hattiesburg. 

“If I can drive 35 to 90 minutes to save 20 families from doing the same, I’m happy to do it,” Dr. Friel said. “The financial burden for some of our rural families to seek care is substantial. Visiting outlying clinics allows me to meet patients where they are, or at least meet them halfway.” 

A direct nurse helpline and all-in-one patient portal enhance accessibility. “When patients call our phone line, there’s no phone tree to deal with,” Dr. Friel said. “My nurse answers the call, or patients can leave a voicemail and receive a call back. Our integrated patient portal system allows families to schedule appointments and follow-ups, send providers a message, and see their child’s imaging studies in real time.” As patient volumes have expanded, so has the cleft and craniofacial team. The group includes pediatric craniofacial and reconstructive surgeons, pediatricians, speech-language pathologists, pediatric otolaryngologists, pediatric neurosurgeons, dentists, orthodontists, audiologists, psychologists, geneticists, social workers and cleft team coordinators. Soon, the team will double its capacity to treat patients with cleft lip and palate by adding a second pediatric plastic surgeon and a third pediatric neurosurgeon.

 Managing complex craniofacial conditions requires collaboration between pediatric neurosurgeons and plastic surgeons. The cleft and craniofacial program offers same-day, coordinated visits with both specialists. 

Providing Complex Craniofacial Care 

The cleft and craniofacial team treats numerous complex disorders, including rare ones, such as syndromic craniofacial conditions. According to Dr. Friel, the team treats these conditions in higher volumes than expected relative to the New Orleans and Louisiana populations, and he expects those volumes to increase as the team grows. 

“Our team performs the most advanced minimal access techniques for craniofacial surgery, including spring cranioplasty, an option early on for multisuture syndromic craniosynostosis,” Dr. Friel said. “We also offer craniofacial distractions, LeFort 3 distraction and monobloc distraction.” 

Dr. Friel also holds subspecialty board certification in hand surgery, allowing him to treat congenital hand differences in children with syndromic craniosynostosis. 

Advancing the Field 

Beyond the clinic and operating room, Dr. Friel shapes the future of cleft and craniofacial care and performs repair surgeries in far-flung corners of the world as part of medical missions. 

Dr. Friel was the pediatric plastic surgery editor for Annals of Plastic Surgery for 10 years. He recently stepped down to focus on publishing his program’s results. 

“I’m beginning to publish works based on our large dataset and patient outcomes,” Dr. Friel said. “This is exciting work with excellent statistical power and results that rival or exceed many traditional bastions of pediatric care throughout the country.” 

This fall, Dr. Friel will present his work on syndromic craniosynostosis at the 21st Congress of the International Society of Craniofacial Surgeons in Shanghai. 

Serving Abroad 

Dr. Friel’s commitment to transforming the lives of children with cleft lip and palate has taken him on medical missions with nonprofits LEAP Global Missions and Operation Smile. He has treated children in Belize, China, the Dominican Republic, India, Paraguay and the Philippines, and will return to Belize with a medical team this fall. 

“One of the wonderful things about plastic surgery is that I don’t need sophisticated robots or scopes to repair a cleft lip for a child who would otherwise have had no chance of treatment,” Dr. Friel said. “Thanks to advances in pediatric anesthesia, I can safely repair a cleft lip and palate in the developing world with a basic instrument setup and sutures. It’s one of the most rewarding parts of what I do.” 

According to Dr. Friel, medical missions can include some of the most advanced surgeries performed anywhere. Some participating physicians see cleft volumes in their countries far exceeding those in the U.S. As a result, the potential for learning and exchanging ideas is “profound,” he said. 

Additional Growth Ahead 

Moving forward, Dr. Friel envisions the cleft and craniofacial program expanding its reach even further in Louisiana and Mississippi, especially as the team increases to two pediatric plastic surgeons and three pediatric neurosurgeons. 

“I think we’ll begin to see more and more patients seeking our expertise for cleft and craniofacial conditions,” Dr. Friel said. “With the state-of-the-art Debra H. and Robert J. Patrick Neuroscience Institute opening in 2026 and the new Gayle and Tom Benson Ochsner Children’s Hospital following in 2028, this is an exciting time for our program.” 

How to Refer

Learn more about pediatric plastic and reconstructive surgery at Ochsner, or refer a patient.