Cleft Lip and Cleft Palate
Cleft Lip and Cleft Palate is one of the most common and also one of the most correctable birth defects. A cleft lip is usually surgically closed by 3 months, and a cleft palate by one year. Children born with cleft lip and cleft palate are ideally evaluated and treated by an interdisciplinary team of healthcare professionals, including the pediatric plastic surgeon that does the repairs on the lip and palate. The Division has an outstanding history in the treatment of children with facial birth defects with several of its faculty involved with the UNC Craniofacial Center and the American Cleft Palate-Craniofacial Association.
Craniosynostosis is a birth defect of the skull, characterized by the premature closure of one or more of the fibrous joints, or sutures, between the bones of the skull. Closure of a single suture is the most common. The abnormally shaped skull that results is due to the brain not being able to grow in its natural shape because of the closure. Rather, it compensates with growth in areas of the skull with the least resistance, ie, where the sutures have not closed. The first sign of craniosynostosis is an abnormally shaped skull. Other considerations can include signs of headaches, intracranial pressure, developmental delays and in rare instances, seizures and blindness. Craniosynostosis should not be confused with Deformational Plagiocephaly, a condition of cranial asymmetry caused by sleep positioning, the most common being unilateral flattening of the occiput. The diagnosis and treatment of craniosynostosis should be made by a trained pediatric craniofacial surgeon using clinical evaluation and sophisticated radiographs. True craniosynostosis is corrected by surgery, whereas deformational plagiocephaly can be alleviated by repositioning the infant during sleep or in more severe cases, using a molding helmet.
The Division offers timely evaluation and diagnosis of these two conditions and works closely with the Division of Neurosurgery when surgery in indicated.
Microtia and External Ear Deformities
Microtia is a congenital deformity of the external ear where the auricle, the external ear, is mildly to severely deformed. The treatment of microtia involves staged, surgical reconstruction of the external framework Treatment occurs when patients are between the ages of 5 and 8 or when there is sufficient rib growth to provide the quantity of cartilage needed by the surgeon to construct the framework of the ear. Ear reconstruction is one of the most challenging procedures in Plastic Surgery, requiring precise technique and creative artistry.
Another external ear deformity, prominent ears, is corrected by a procedure called otoplasty where the surgeon will set the ears back closer to the head, or reduce the size of large ears. Ears are almost adult size by age 5; therefore this procedure is usually done between the ages of 4 through the teenage years.
Vascular and Lymphatic Malformations
Congenital vascular lesions or malformations are a collection of dilated blood vessels that gradually enlarge. Hemangioma is a common and generic term to describe a variety of vascular lesions with different etiologies and natural histories, but that predictably undergoes a process of involution. Lymphatic lesions or lymphangiomas grow commensurately with the child, sometimes enlarge, or may improve with time. Regardless, contemporary terminology of vascular lesions can challenge the best of pathologists and clinicians alike. Clinical diagnosis can be made by a plastic surgeon, then treatment recommendations and options discussed. If surgery is recommended, these lesions are always reviewed by pathologists for a definitive diagnosis.
A nevus is a common skin growth composed of special pigment-producing cells called nevomelanocytes which are related to pigment producing cells normally found in the skin, called melanocytes, and has been present since birth. Nevi grow in proportion to body growth. Most nevi are important because of their relationship to a potentially deadly skin cancer called melanoma. Children with large nevi may have a higher concentration of these abnormal cells, and therefore surgical excision of the nevus is recommended. The plastic surgeon will review in detail the manner in which the nevus will be surgically removed, taking into consideration appearance as well as removing as much of the nevus (in the case of Giant Nevus) as possible.
Scars develop when the top layer of skin, the epidermis is injured, cut or broken and extends down into the second layer, called the dermis. Since the body is unable to repair the damaged skin tissue to its original state, the wound is repaired by connective tissue. Connective tissue is not as strong or durable as normal skin, and may have a different skin tone. Scars grow and mature over time and in about ten percent of all scars, the connective tissue continues to grow above or beyond the original wound, or injury site. These scars may look red, raised or expanded. Surgery may be recommended upon consultation, as well as laser treatment or steroid injections.