Cleft Lip & Palate Program

Cleft Clinic - Dr. Larry Hartzell and Patient Langstyn Hall

The Cleft Lip and Palate Program at Arkansas Children's Hospital incorporates an interdisciplinary team, with each member specialized in pediatric care. An important advantage of the team approach is that the team's professionals are in direct and continuous communication about the child's care. The goal of the team is to ensure that care is provided in a coordinated, consistent manner with the proper sequencing of evaluations and treatments within the framework of the child's overall developmental, medical and psychological needs.

Each team member is fully aware of the child's specific needs and progress and is able to make recommendations for care which are consistent with those given by other team members. The Cleft Lip and Palate Team at ACH is fully accredited by the American Cleft Palate Association (ACPA) and is one of many programs at ACH which provide high quality, individual service to children with special health care needs. Since 1978, almost all children born in Arkansas with cleft lip/palate have been treated at ACH. The team was started by world-renowned pediatric otolaryngologist Dr. Robert Siebert who passed down his knowledge to Dr. Larry D. Hartzell. Since taking over the team in 2012, Dr. Hartzell has grown the team to consist of three surgeons, one ENT, Dr. Larry D. Hartzell who directs the cleft-craniofacial plastic surgeon, Dr. Michael Golinko, and Dr. Adam Johnson.

The Role of the Plastic Surgeon 

Dr. Golinko, a craniofacial plastic surgeon, is one of the cleft surgeons that is part of the Arkansas Children's Cleft Team, led by Dr. Larry Hartzell.  

Cleft care is often considered at the heart of any pediatric plastic surgeon's practice for a variety of reasons.  Though the first known cleft repair dates back nearly 2000 years to China, the modern cleft repair that we use today, the rotation-advancement repair, was devised and popularized by the late Dr. D. Ralph Millard, a plastic surgeon at Miami Children's Hospital. Over his career, Dr. Millard trained hundreds of plastic surgery fellows and residents and his repair, or variations of it, are now performed in nearly every cleft center in the world. 

Pediatric plastic surgeons typically have a minimum of 3 years of plastic surgery training, of which approximately 25% is devoted entirely to cleft, craniofacial and pediatric plastic surgery. Moreover, the plastic surgeons at Arkansas Children's have completed an additional year of specialty training in exclusively cleft and craniofacial surgery. All plastic surgeons at Arkansas Children's are board certified by the American Board of Plastic Surgery (ABPS). Certification involves not only a written exam, but an oral exam, in which the surgeon's entire case log is submitted for review.   For 5 cases selected by the board, the candidates must submit the entire medical record including pre and post-operative photographs for review.  Finally, every November, candidates must sit before the board and be examined on 5 selected cases and 5 standardized cases. 

The Arkansas Children's Cleft Team has a unique group of cleft surgeons from different disciplines to provide comprehensive care for your child.  The plastic surgeon's expertise lies in primary cleft lip and palate repair, bone grafting, jaw lengthening (distraction), jaw surgery and nose surgery (rhinoplasty). 


ENT surgeons, Dr. Hartzell and Dr. Johnson not only perform the primary cleft repair and bone grafting but provide comprehensive expertise in otologic and airway issues that may arise.  Drs' Hartzell and Johnson also co-direct the Velopharyngeal Insufficiency Clinic ( VPI) dedicated to both cleft and non-cleft patients experiencing speech disorders.  In addition, the Oral-maxillofacial surgeon, Dr. John K. Jones, has unique expertise in both dentistry and oral surgery and provides expertise in both bone grafting, jaw surgery and implant dentistry.    

A more recent advance in cleft care that makes this repair easier for the cleft surgeon is Nasoalveolar Molding (NAM). NAM was originally developed by an  ENT & Plastic Surgeon, Dr. Court Cutting, and craniofacial orthodontist, Dr. Barry Grayson at New York University (NYU) and is now available with all surgeons at Arkansas Children's.  Not all babies with clefts are candidates for NAM, but for those that are, the retainer-like device can greatly help to narrow the width of the cleft, the gums and improve nasal shape.