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| Craniofacial |
The UAB Cleft and Craniofacial Center Mission: We are an interdisciplinary team of specialists whose mission is to deliver the highest quality treatment for patients with facial differences. We strive to do so in a thoughtful and compassionate manner, which provides support and assurance to the families of our patients.
Our center provides families and patients with comprehensive information about facial birth defects, facial deformities due to trauma and facial differences due to tumors. This information will allow them to better understand and participate in, the treatment plan chosen. We then provide the professional expertise and dedication necessary to accomplish that plan with a minimum number of surgical procedures. For more information, please contact us at 205-939-9369.
Our team includes: Audiologists, Craniofacial Surgeon, Geneticist, Neurosurgeons, Nurses, Occupational Therapists, Oral and Maxillofacial Surgeons, Orthodontists, Otorhinolaryngologists (ENT), Pediatrician, Pediatric Anesthesiologists, Pediatric Dentists and Prosthodontists, Pediatric Radiologists, Physical Therapists, Plastic Surgeons, Speech Language Pathologists and Surgeon's Assistant and Clinic Coordinator.
We treat a wide variety of facial differences including, Amniotic Band, Apert Syndrome, Cleft Lip and or Palate, Craniosynostosis, Crouzon Syndrome, Encephalocele, Fibrous Dysplasia, Frontonasal Dysplasia, Goldenhar's Syndrome, Hemifacial Microsomia, Hypertelorism, Microtia, Obstructive Sleep Apnea, Orthognathic Problems, Post Traumatic Facial Differences, Saethre-Chotzen Syndrome and tumors of the face.
Timing
In general, we prefer to see children soon after birth, in order to assess feeding ability and provide early information to concerned family members. Thereafter, visits are individualized to the patient's diagnosis and specific medical needs. Full follow-up is provided through early adulthood. At the first visit, many or all of the above specialists will see the child. The team will then provide a summary opinion of our recommendations, in writing, to the patient's primary care physician as well as to the family. Input from the parents is encouraged. Once the child is old enough, they too are included in the decision making process. An effort is made to maximize outcome with a minimum number of operations in all cases. However scar healing is an individual trait, and some children need small revisions at various times.
Facial Trauma
Complex facial trauma is ideally managed acutely, within days after the injury. Complex craniofacial injuries are managed in a team fashion analogous to the approach used for congenital facial differences. This team approach leads to a more efficient and comprehensive treatment plan. Facial deformities arising as a consequence of trauma can also be managed in a delayed fashion. Some individuals may experience facial growth disturbances after trauma. Others have persistent post-traumatic deformity after severe facial skeletal and or soft tissue injuries. In many cases, secondary correction of these disturbances (even years after the original injury) can be accomplished to improve function and self esteem. Again, a team concept is utilized in an effort to optimize outcomes and to minimize surgical procedures.
Tumors
Removal of certain types of tumors may also benefit from a team approach. Surgeons with different, but complementary training and skills can combine these talents to allow safe removal of the tumor and immediate reconstruction of any bony or soft tissue defects. This team approach has been demonstrated to allow for more complete tumor removal, shorter hospitalization and a lower complication rate.
Craniofacial Surgery
Craniosynostosis is the premature fusion of the growth centers of the skull. It may involve single or multiple sutures (growth joints between the bones of the skull). Fusion of a particular suture will result in a characteristic head shape. It is generally believed that fusion of a single suture does not cause a significant increase in pressure on the brain. Correction is carried out for reasons of appearance and to aid psychosocial development. In some cases a fused suture can cause a twisting of the face, which could result in dental abnormalities if not corrected. Multiple fused sutures are thought to increase pressure on the brain, and may risk injury to brain function and vision if left uncorrected. Careful evaluation by the neurosurgeons as well as a craniofacial surgeon, pediatrician and a pediatric ophthalmologist will help to determine timing of surgical intervention. In general, surgery for craniosynostosis is carried out at age three to ten months. It involves a three to five day stay in the hospital.
The need for craniofacial surgery is highly individualized. Consequently the timing of craniofacial surgical procedures is customized (whenever possible) by the team to best meet the needs of the patient. Every effort is made to carry these procedures out in such a manner that the number of surgical procedure is minimized. Midface hypoplasia is seen in a number of syndromes such as Apert and Crouzon Syndrome. Surgery can be performed to move the facial bones forward. This is done to improve eye protection, to improve the airway (or breathing passages) and to help with alignment of the teeth. The timing of such surgery may vary depending on the individual patient's needs. The earliest age for midface advancement would be four years of age (for example to allow removal of a tracheostomy). However midface advancement at this early age may increase the likelihood of a repeat procedure later in life. In general, surgery for conditions such as facial clefting, fronto-nasal dysplasia, Treacher-Collins Syndrome and hemifacial microsomia are dictated by the severity of the condition as well as the specific anatomic region to be addressed. For example skull growth is very rapid until age three years, then slows dramatically. The orbits (eye sockets) are mature by approximately age ten years. The tooth bearing facial skeleton will continue to mature until age 14-16 years in girls, and 16 to 18 years in boys. Discussions with the patient, family and craniofacial team, help to prioritize issues of greatest concern.
Orthognathic Surgery
"Ortho" means to straighten or align, and "gnathic" means jaw so orthognathic surgery means, surgery to straighten the jaws and improve function. Frequently children born with facial differences have disproportionate growth of the jaws. Cleft palate may cause a small upper jaw (maxilla) and a relatively larger lower jaw (mandible). Sometimes the bones of the jaws can be small, fused, or even missing as in hemi-facial microsomia. Facial syndromes, such as Crouzon, Apert, Pfieffer etc. may affect the size of the jaws, and require surgery, after the child's growth is complete. Fractures of the jaws may sometimes affect their ability to grow normally. In some injuries, the jaws may have healed in a way that affects alignment. The lower jaw is the one that moves, so abnormal growth or position may affect, eating, chewing, talking and/or breathing. In such cases surgical repositioning of the jaws can frequently be beneficial. In teenage patients, orthodontic braces are needed to straighten the teeth, before jaw surgery. Our team orthodontists and oral surgeons will work together to develop a treatment plan which minimizes the time spent in braces.
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