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Conditions We Treat

The Craniofacial Center at the Children's Hospital at Montefiore is a source of hope to those parents whose newborn child has a birth defect such as a cleft palate, misshapen head or facial birthmark. We commonly offer cutting-edge care for conditions such as:

Cleft lip and cleft palate
Occurring in about one in 600 births, cleft lip and palate (roof of the mouth) are the most commonly seen conditions at the Craniofacial Center. Children can be born with a cleft, or separation, of just the lip or both the lip and palate. Each child's treatment is planned carefully, to give the best possible functional and cosmetic result. Cleft lips are generally be repaired at three months of age, while cleft palates can generally be mended at nine to twelve months of age. Older children are also offered reconstructive surgery of nose deformities that may accompany a cleft lip and palate. Our multi-disciplinary team includes pediatric ear, nose, and throat doctors and speech pathologists who assist children who also suffer from hearing and speech problems, and pediatric dentists who perform gum surgeries to allow for normal dentition.

A small amount of children with a cleft palate are found to have Pierre Robin sequence, which is a constellation of congenital abnormalities which include a very small jaw and retracted tongue in additional to the cleft palate. Our team has vast experience treating these children and their increased risk of having breathing difficulties. Please see the section below on mandibular hypoplasia for more information on one option our team uses to treat this risk.

Mandibular hypoplasia
Mandibular hypoplasia is the term which describes the presence of a small jaw. It can manifest from multiple craniofacial abnormalities including Pierre Robin sequence, hemifacial microsomia, Treacher-Collins Syndrome, and Goldenhar Syndrome. In young children, a jaw with inadequate length can inhibit normal breathing, especially while sleeping. In the past these children often required a tracheostomy, which is a tube placed directly into the windpipe through the neck, to allow for unobstructed breathing. Our craniofacial surgeons give parents an option to avoid the placement of this tube, or allow for its removal if it has already been placed, by performing a surgery called mandibular distraction. This surgery lengthens the mandible to a more normal size, opening the child’s airway and relieving the obstruction. These children typically have complex medical histories and are often cared for by the pediatric intensive care specialists after surgery.

Hemifacial Microsomia 
A condition affecting the face, jaw, and ears in which the tissues on one side of the face are underdeveloped. As the 3rd most common congenital abnormality, our craniofacial specialists are extremely talented at treating the wide variety of presentations of this condition. The degree of facial asymmetry of an affected patient can range from subtle difference in the fullness of one cheek compared to the other, to the complete absence of one ear. Treatment plans are tailored to each patients needs but often include the transfer of fat into the face, reconstruction of the ear (described below), chin surgery, or jaw lengthening (see mandibular hypoplasia above)

Microtia 
This condition refers to children born without ears. Our surgeons have improved techniques to construct ears for patients using their own tissue.

Ear Reconstruction
Ear reconstruction is needed by patients with congenital abnormalities as well as following traumatic injuries to an ear. Microtia refers to the underdevelopment of one or both ears at birth. The degree of severity for both congenital and traumatic problems range from absence of a small portion of the ear to complete absence of the external ear and ear canal. The Craniofacial Center at CHAM specializes in reconstruction of the ear using a patient’s own tissues instead of an artificial implanted material. It is typically a 3-4 stage surgery which begins when the patient is atleast 6 years of age. For patients who have hearing loss associated with their microtia, our department of audiologists is utilized to address these concerns.

Craniosynostosis
A condition in which the sutures, or joints between the individual bones in the skull of an infant close too early, causing problems with normal skull growth. Parents may notice the development of an irregularly shaped head or possibly feel bony ridges along the child’s skull. A procedure call cranial vault remodeling is performed by our neurologic and plastic surgeons to restore a normal appearance to the skull and prevent any further abnormality. Our center’s unique approach to correcting this problem allows the child to be back to all their normal activities within a couple weeks, without the need for a protective helmet.

About 6% of children who suffer from craniosynostosis have a genetic mutation based syndrome which leads to multiple abnormalities throughout the body. The most common syndromes are Crouzons, Aperts, and Pfeiffers Syndromes. The Craniofacial Center at CHAM is staffed with geneticists, cardiologist, neurologists, and many other specialists who aid in the complex care of these children.

Positional Plagiocephaly
An abnormal head shape characterized by flattening of the back of the head and forehead in newborns which has grown increasingly common since parents are now instructed to have them sleep on their backs instead of belly. Unlike craniosynostosis, this abnormal head shape is due to prolonged pressure on the back of the head, not early close of the sutures of the skull. Early, non-invasive treatment (before 1 year of age) involves decreasing the infant’s time on their back and possibly the use of a molding helmet. These interventions are very successful in correcting this problem and avoid the need for any surgery at an older age.

Hemangioma
Hemangiomas and other vascular lesions are very common at birth, affecting up to 10% of infants. Due to the multiple classifications of these lesions, we carefully educate patients and caregivers about the wide range of treatment options depending on their individual diagnosis. Hemangiomas typically resolve on their own over a period of years and only need intervention if they affect vital structures. Other vascular skin abnormalities, such as port wine stains, do not resolve and can be treated by our dermatology experts with laser treatments.

 

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