Plastic surgeons and orthodontists at Hassenfeld Children’s Hospital at NYU Langone provide treatment for children with craniosynostosis, cleft lip, cleft palate, and other congenital conditions that can affect breathing, hearing, eating, and swallowing, as well as appearance. We also provide reconstruction for children after injury or cancer treatment. We care for children of all ages and provide prenatal consultations.
In many of the more complex cases, we combine medical photography of the facial anomaly with your child’s x-ray images to create a surgical plan that offers the best functional and cosmetic outcome. Our advanced surgical techniques provide treatment for the following congenital conditions and facial differences.
The skull is composed of plates of bone that are joined together at joints called sutures. These flexible sutures allow for normal brain growth. Craniosynostosis occurs when the plates fuse together too soon, before the brain has had a chance to develop as needed. This can cause the skull to develop an abnormal shape, and in extreme cases can affect brain growth.
Our pediatric plastic surgeons work with our pediatric neurosurgeons to perform craniectomy for most forms of craniosynostosis, including Apert syndrome, Carpenter syndrome, Crouzon syndrome, Muenke syndrome, Pfeiffer syndrome, and Saethre-Chotzen syndrome. We specialize in minimally invasive endoscopic craniectomy, which uses small incisions and miniaturized devices to remove and reshape bone to allow for improved appearance and give the brain room to grow.
Cleft lip and cleft palate are congenital conditions that can also occur as part of other syndromes or disorders, such as Pierre Robin sequence. Treatment often begins with nasoalveolar molding (NAM), an orthodontic procedure first developed at NYU Langone. This can begin shortly after birth, and involves the use of a custom-made oral appliance that aims to gently move the lip and palate closer together while also shaping the nose in preparation for surgery. NAM therapy can reduce the overall number of surgeries your child needs to repair the cleft.
Cleft lip repair surgery is typically performed within the first few months of life. Cleft palate repair generally takes place later, but within 12 months. Treatment may require multiple surgeries.
Children with cleft lip or palate may benefit from additional treatments and surgeries as they grow, including orthodontic care to correct misaligned teeth and, when necessary, surgery to move the lower jaw into the proper position.
Many types of congenital skin lesions and birthmarks can affect a child from birth. Hemangioma is caused by a buildup of blood vessels that create a red birthmark on the face. Arterial and venous malformations are abnormally formed blood vessels that appear as port wine stains and can result from Klippel-Trenaunay syndrome.
When a child has one of these conditions, we work with doctors from the Hemangioma and Vascular Malformations Program to evaluate whether surgery is required. If treatment is needed, laser therapy or embolization is the first treatment option. During this outpatient procedure, medication that stops blood flow to the lesion is injected into the surrounding blood vessels. Several treatments are often needed. Other treatment options include steroid medication and several different surgical procedures. Doctors often use a combination of treatments.
There are many causes of and types of facial differences that can be improved or treated by plastic surgery. Procedures are performed throughout childhood, depending on the type of severity of the difference. Facial differences that we commonly treat include hemifacial macrosomia, where half of the face is smaller than the other and the jaw is uneven.
Children with microtia have a small, abnormally shaped or missing external ear. Microtia may occur on one side only or affect both ears. This condition is almost always accompanied by aural atresia, which happens when the external ear canal is either incomplete or absent. Children with microtia and aural atresia do not have normal hearing in the affected ear but may have normal hearing in the other ear.
Our experts also treat children with macrotia, which is a prominent ear; cryptotia, which occurs when the ear appears to be buried or hidden in the side of the head; and Stahl’s ear, which causes the ear to appear pointed due to an extra fold of cartilage. We also provide otoplasty, which is surgery to improve the appearance of the ear.
Conditions that affect the appearance of your child’s ear may also impact his or her hearing. With infants, our first priority is to make sure your child can hear well enough to allow for normal language development. An audiogram, which is a graphic display of your child’s hearing ability, is recommended so that we can determine whether your child needs a hearing aid. We might also recommend other types of hearing tests, depending on your child’s age and whether one or both ears are affected.
Many of our patients are either born with incompletely developed noses or misshapen noses, or they’ve developed nasal differences that require correction. In these situations, we take into account the function of the nose, how patients are breathing and sleeping, as well as the appearance of the nose. Surgery to reshape or restore the nasal anatomy is designed to optimize appearance and function, including optimal breathing. We also perform cosmetic enhancements to the nose.
Conditions such as Treacher Collins syndrome often require reconstruction of the jaw. Our plastic surgeons work closely with our pediatric orthodontist, who designs a treatment strategy that focuses on healthy jaw alignment, which is important for function as well as appearance.
Children with cleft lip, cleft palate, and other craniofacial conditions often benefit from orthodontic care to realign the teeth. Orthodontic care can also be beneficial for children with missing teeth or a jaw that is too small, large, wide, narrow, or asymmetric; as well as those who have been treated for cancer or who have had a traumatic accident. Our orthodontist also helps improve the look of a child’s smile, particularly a smile that is too narrow, shows too much or too little teeth, or is asymmetric.
In addition to using NAM for cleft lip and cleft palate, our orthodontist uses fixed braces and clear braces to move the teeth, as well as fixed and removable orthopedic appliances. We also use micro-osteoperforation, a surgical technique that uses small fractures to stimulate bone growth and accelerate the movement of teeth.
Treatment is provided in our dedicated dental laboratory, which provides advanced imaging, including x-ray and CT scanning, that provides intricate three-dimensional scans of your child’s teeth and jaw. We also use simulators to predict future tooth movement; this helps us develop appropriate treatment plans.
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