Reconstructive Pediatric Surgeries
Reconstructive pediatric surgeries address birth defects, congenital birthmarks, burns, scars, trauma, or any other conditions that may affect the child’s normal function or attract unwanted attention. Commonly treated conditions are birthmarks, vascular anomalies or malformations, burns, cleft palate and lip, ear deformities, extremity deformities, traumatic injuries, or other craniofacial deformities including craniosynostosis (premature fusion of one or multiple sutures in the skull).
Cleft lip with or without cleft palate is the most common craniofacial deformity with prevalence around 10 in 10000 live birth. Children with cleft lip and/or cleft palate requires repair to restore oral function including eating and speech. Cleft lip repair surgery is often performed when the affected child is 3 months of age and at least 10 lbs in weight. Cleft palate repair is performed between 10-12 months prior to formal speech development. Children with cleft requires frequent follow up with craniofacial surgeon, speech therapist, ear nose and throat specialist, and pediatric dentist to monitor their development and address any potential issues associated with their cleft. Cleft patients may require speech surgery around age 5-6, bone grafting around age 8-10, jaw surgery once they fully grown, and rhinoplasty as cleft lip often affect the growth of the nose as well.
Craniosysnostosis is the second most common craniofacial abnormality with prevalence around 4 in 10000 live birth. Infants have multiple sutures (open areas between the skull bones) which allow rapid growth of their skull to accommodate the growing brain. All sutures are normally remain open until adulthood except for metopic sutures (which usually closes between 6 and 12 months of age). When one or a combination of the sutures fuse prematurely, the skull shape becomes abnormal because growth is restricted in certain areas. This is not only affecting the appearance of the child but can also affect their brain development. In general, surgical correction can be performed as early as 3 months and as late as two year of age for milder cases (in which suture is only partially fused). Surgery is best performed through a team approach with neurosurgery and plastic surgery involvements.
Hemifacial microsomia is another common craniofacial abnormality. This condition usually affects the ears however facial asymmetry, in particular asymmetrical jaw growth, is also common. Ear reconstruction and jaw re-alignment may be necessary in severe cases. Sometimes, both sides of the face can be affected. The most two common approach to ear reconstruction are using the patient’s own rib cartilage or implants. In case of implant-based reconstruction, there is a lifetime risk of implant failure however it can be done sooner, as early as 4 year old as compared to rib cartilage reconstruction which are normally performed between 6-10 year of age. Implant reconstruction can be performed in one stage while depending on the severity of the ear, rib cartilage reconstruction may require one to two stages.
Birthmarks are general terms that refer to both pigmented skin lesion and vascular lesions (hemangiomas or vascular malformations). In general, true birthmarks are moles, not vascular lesions. Treatments are often depending on which type of tissue is affected. Giant congenital melanocytic nevi (big dark mole) have risk of transformation to melanoma, therefore surgical removal is often recommended. Most other types of birthmarks (including vascular birthmarks) can be treated with injection (sclerotherapy) or laser.
Who is a good candidate for reconstructive pediatric surgery?
Children with any congenital or acquire deformities that can cause them functional and/or emotional problems (such as being bullied at school) are strongly encouraged to pursue reconstructive surgery. The FDA has warned that “repeated or lengthy use of general anesthetic and sedation drugs during surgeries in children younger than 3 years may affect the development of children’s brains”. Therefore, timing of the surgery and the number of surgeries required to address the child’s deformity would be thoroughly discussed with parents during initial consultation.