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Pediatric Plastic & Reconstructive Surgery FAQs

General Questions

If my child has a cleft deformity, when is the appropriate time for a consultation?
The appropriate time for an initial evaluation is in the first few days after birth.  It is important for an experienced expert in cleft deformities to assess your child and determine his or her ability to feed appropriately.  If your child has a cleft palate, a special technique of feeding your child is necessary.  Also, you will have an understanding of the different operations he or she will need during the first year of life and thereafter.

What is plagiocephaly and what are the different causes of plagiocephaly?
Plagiocephaly simply means a deformed skull.  Plagiocephaly can be caused by position, called positional plagiocephaly, or by fusion of a growth plate in a child's growing skull, called craniosynostosis. 

When does plagiocephaly require orthotic helmet therapy?
If your child has positional plagiocephaly, then your child may benefit from cranial orthotic helmet therapy, more commonly known as 'helmet therapy'.  This should be determined by a pediatric plastic surgeon with fellowship training in craniofacial surgery in order to differentiate positional plagiocephaly from craniosynostosis.

When does plagiocephaly require surgical treatment?
If you child has craniosynostosis, the only way to correct the mis-shapened skull is to perform an operation called craniofacial reconstruction.  The skull bones have fused too early and do not allow for expansion of the skull as the brain is growing.

What is the Craniofacial Team?
The Craniofacial Team is designed to provide comprehensive, coordinated care for a child born with cleft lip and palate deformities, craniosynostosis, hemifacial microsomia and other complex facial deformities.

What is jaw distraction and when is this technique used?
Jaw distraction is a technique to lengthen the mandible or maxilla. This technique is used to lengthen the mandible (lower jaw) or maxilla (upper jaw) to correct for abnormal deficient growth. There are several reasons to use this technique. For severe micrognathia, when the mandible is very small, mandible distraction is used to lengthen the mandible and move the tongue more forward to relieve airway obstruction. For hemifacial microsomia, when one side of the mandible is underdeveloped, mandible distraction is used to lengthen the mandible to restore a more normal occlusion of teeth.

What is the Jaw Team?
The Jaw Team or Orthognathic Team is designed to provide comprehensive, coordinated care for complex problems involving the mandible and maxilla and the occlusion of teeth.  The members of the team include a pediatric plastic surgeon, oral and maxillofacial surgeon, orthodontist, and dentist.

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Hemangiomas and Vascular Malformation

What is a hemangioma?
A hemangioma is a vascular capillary tumor. At birth, a reddish skin color is present. After one month, the hemangioma begins to grow rapidly in size for the next several months. The growth of the hemangioma slows down until the peak size is reached at approximately the eighth month. Then involution of the hemangioma will begin, usually after one year, but the involution will take many years to complete. Just because the reddish discoloration goes away does not determine whether your child will be left with a skin deformity. Oftentimes, the hemangioma will create a scar or leave behind an irregular skin contour with soft tissue fullness.

If my child has a hemangioma, what are the indications for an operation and when?
There are a few important and clear-cut indications for surgical intervention. If a hemangioma obstructs an important structure of the face, such as the eye, nose, or mouth, this is a clear indication for surgical removal. If a hemangioma is large and protuberant and is going to leave a permanent skin deformity, this is a relative indication for surgical removal.

When the hemangioma involves the face, then this is a more clear indication for surgical treatment by an experienced pediatric plastic surgeon. If the hemangioma is flat, then time alone may be the best option. Only when the hemangioma is superficial and causing red discoloration and the hemangioma is flat should laser be considered. Laser will only take the red discoloration away after several treatments. Laser is not effective to reduce the size of the hemangioma or improve the contour of the abnormal skin.

What is a vascular malformation and why is it different from a hemangioma?
A vascular malformation is abnormal development of small veins (called a venous malformation) or small arteries and veins (called an arterio-venous malformation). Unlike a hemangioma, the vascular malformation is often noticeably present at birth and will continue to grow along with the person through childhood and as an adult. Port-wine stain is an example of a venous malformation.

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What is microtia?
Microtia means small ear. Usually many parts of the ear are missing or abnormally shaped. A total ear reconstruction is recommended as early as four years of age.

What are the different options for ear reconstruction?
There are two techniques for total ear reconstruction. The traditional approach is using the child's own rib cartilage. The rib cartilage is harvested from a child's chest and shaped into the framework of an ear. This technique requires approximately 4 to 5 operations to completely create an external ear. A child must be 7 to 10 years of age in order for the rib cartilage to be large enough to use to create the ear framework. The modern approach is to use a porous plastic implant called MEDPOR and cover this implant with the child's own natural tissue and skin. This operation can be performed when a child is 4 years of age, since his rib cartilage is not needed for the total ear reconstruction. Usually, only 2 operations are necessary to completely create an external ear.

Why is the MEDPOR technique better than the more traditional technique with rib cartilage?
The MEDPOR plastic implant technique is superior for three important reasons. First, the final appearance of the ear from a MEDPOR total ear reconstruction matches very closely to the natural ear of a human being. The usual result from a rib cartilage total ear reconstruction is very mediocre to poor, without any true resemblance of a normal ear. Second, the MEDPOR total ear reconstruction can be performed at 4 years of age, which decreases the chance for psychological trauma during the important changes that occur between 5 and 10 years of age. Third, only 2 operations are usually needed to complete a total ear reconstruction rather than the 4 or 5 operations customarily needed for the rib cartilage total ear reconstruction.

What age is appropriate for total ear reconstruction and why?
The earliest age recommended for total ear reconstruction is 4 years of age. At 4 years, a child's ear is approximately 85% adult size. It is very difficult to differentiate this small difference in size, since it is very difficult to see both ears at the same time. Only the MEDPOR total ear reconstruction technique is possible at 4 years of age, since the child's own rib cartilage will not be needed.

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Congenital Nevi 

What is a congenital nevus?
A congenital nevus is a type of pigmented skin birthmark. 

What is a giant nevus and what are the different options for treatment?
A giant nevus is an abnormal growth of a mole on any part of the body. The size of the giant mole varies a lot. The treatment for a giant mole is determined by size and location. Different plastic surgical techniques are employed for lesions involving the face versus the scalp versus the arm or trunk of the body.

Why should a congenital nevus be surgically removed?
Some types of congenital nevi will continue to grow abnormally as the child grows older. It is easier to surgically remove a pigmented skin lesion when it is small. It is much more difficult to remove when the size is larger. 

Is laser an option to treat a congenital nevus?
Laser is usually not a good option for a nevus. The nevus usually is located in the deeper part of the skin. Therefore, surgical removal is recommended to avoid recurrence of the nevus.

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Other Questions

Do you treat problems other than deformities involving the face and skull?
Yes, our practitioner is both a pediatric plastic surgeon and a craniofacial surgeon. There are very few people trained in both areas. 

How many pediatric plastic surgeons practice in the country, with their practice devoted to taking care of children?
Not many. There are very few positions (less than 30 positions in the United States) where, we are devoted primarily to pediatric plastic surgery, including craniofacial surgery.

Do you work with pediatric anesthesiologists?
The Maria Fareri Children's Hospital is staffed with fellowship trained pediatric anesthesiologists.

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