Pediatric plastic surgery encompasses a variety of surgical procedures that correct both the appearance and function of a child. When surgery is necessary, it is usually due to either a condition a child was born with (congenital) or a traumatic injury. Common conditions treated by pediatric plastic surgeons include cleft lip and palate, hemangiomas and congenital absence of an ear (microtia).
Dr. Morin was specially trained to operate on infants and children at Miami Children’s Hospital. He understands the important physiologic differences between children and adults and he collaborates with other pediatric specialists in order to achieve the best and safest results.
A cleft lip is one of the most common congenital defects of the face. The deformity consists of a separation of the upper lip into either two or three parts. The deformity often involves the bone beneath the lip and almost always involves the nose. Problems associated with this deformity include difficulty feeding, severely impaired speech, and dental abnormalities. This condition may appear on one or both sides of the face and is sometimes diagnosed on a prenatal ultrasound.
Treatment for a cleft lip begins at birth. It is a problem that involves many entities so a multidisciplinary team approach should always be used. Speech therapists play a vital role initially in feeding and later in the teaching of proper speech. Ear nose and throat (ENT) doctors, nutritionists, dentists, orthodontists, oral surgeons and social workers are involved in the care of these patients as well.
Surgery is usually performed when the child is three to six months old. The procedure is performed under general anesthesia in a hospital setting. By rotating and advancing tissue from both sides of the cleft, the defect can almost always be closed. Children usually stay in the hospital for one night and can go home once they are drinking appropriately.
Repairing a cleft lip is an art with many subtleties and nuances. The procedure should only be performed by surgeons with an appropriate amount of training and skill, in a setting that employs a multidisciplinary team.
A cleft palate is an opening in the roof of the mouth that permits a connection between the mouth and the nose. This condition often occurs in conjunction with a cleft lip and it creates a variety of problems for the patient. Infants born with a cleft palate will experience difficulty feeding and are at an increased risk for ear infections. If the palate is not repaired correctly, problems with speech are virtually guaranteed.
As with cleft lip patients, it is important for an interdisciplinary team to be involved in the care of a cleft palate patient. Surgery is usually performed when the child is between 9 and 14 months old. During this procedure, tissue is elevated from both sides of the defect and subsequently advanced toward the midline to allow for closure. There are several different surgical techniques, however, the most important step is the repair of the abnormally positioned palatal muscles.
A hemangioma is a type of birthmark that appears on the skin as a bright red patch. It is usually present at birth and is the result of a blood vessel abnormality within and underneath the skin. Although hemangiomas can appear anywhere on the body, they are most commonly found on the face, scalp or neck.
Hemangiomas have a tendency to involute or fade significantly as the child grows, however, the tissue left behind is usually abnormal. Treatment of a hemangioma is determined primarily based on its location. Some lesions in non-critical locations can be left alone or treated with medications like corticosteroids or beta blockers. Hemangiomas near the eye, however, require immediate removal if a child’s sight is threatened. Large hemangiomas are often more problematic and removal of these lesions may require additional plastic surgery techniques including tissue expansion.
Velopharyngeal insufficiency (VPI) involves an improper closing of the velopharyngeal sphincter, or the soft palate musculature in the back of the throat. The result is an increase in the nasal air escape which gives a nasal quality to a patient’s speech. This condition would always occur in patients with unrepaired cleft palates, but it also occurs in a percentage of patients even following cleft palate repair.
The treatment of VPI involves a combination of surgery and speech therapy. There are several different surgical techniques used to treat this condition and all of them use one of the muscles in the area of the soft palate or the back of the throat to narrow the velopharyngeal sphincter.
Microtia is a relatively common congenital deformity that results in the absence of one or both ears. Most patients have a partially developed ear, but it usually does not appear or function normally.
The best treatment for microtia involves the construction of an ear using the patient’s own rib cartilage. Proper ear reconstruction is performed over two staged procedures that are spaced approximately 6 months apart. The first procedure should not be performed until the child is at least 9 years old. At that time, rib cartilage is harvested and shaped into the framework of an ear. The cartilage framework is then inserted under the skin in the proper position based on the position of the normal ear on the other side. During the second operation, the back of the ear is elevated and a skin graft is used to give it the appropriate amount of projection.
Dr. Morin recently operated with one of the world’s masters of ear reconstruction, Dr. Francoise Firmin, during a surgical mission to Colombia. Dr. Morin learned the subtle points of a proper ear reconstruction during his time with Dr. Firmin and will incorporate these refined techniques into his treatment of patients with microtia in the United States.
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