Summer 2011

Pediatric Plastic and Reconstructive Surgery

Pediatric plastic and reconstructive surgeons at UCSF Benioff Children's Hospital treat patients with a wide range of conditions, including craniofacial, birthmark and vascular anomalies and hand problems. They offer a multidisciplinary, coordinated approach to complex cases, depth and breadth of expertise, and excellent outcomes.

Center for Craniofacial Anomalies

The Center for Craniofacial Anomalies provides a comprehensive approach to conditions affecting the face, head and neck. Professor William Hoffman, M.D., chief of plastic and reconstructive surgery at UCSF, said, "We come up with a coordinated plan that spans from birth until patients turn 21," “It’s a long-term relationship and commitment."

The center includes plastic surgeons, oral surgeons, orthodontists, geneticists, a social worker, nurse practitioner, speech pathologist and other specialists, and is directed by Karin Vargervik, D.D.S., an orthodontist and the Larry L. Hillblom Professor in Craniofacial Anomalies. The center actively follows 700 patients, seeing most every year.

The most common conditions include cleft lips and palates. Hoffman and Assistant Professor Jason Pomerantz, M.D., usually perform cleft lip repair at 3 months of age. The palate can affect breathing; for safety reasons, cleft palate repair is usually performed around 9 months, when the patient is larger but before speech develops.

Photo: Pomerantz (left), Hoffman (right)

Eighty-five percent of patients without developmental disorders develop normal speech after a first procedure. Some patients require a second procedure to reach this benchmark.

Surgeons usually close cleft patients' gums with a bone graft surgery at age 8 or 9, partnering closely with orthodontists to ensure teeth alignment and adequate upper jaw growth. As chair of the California Coalition of Clefts and Craniofacial Teams, Hoffman played a leadership role in advocating a new state law categorizing medically necessary dental and orthodontic services for cleft palate and associated craniofacial anomalies as a medical expense. The law became effective on July 1, 2010.

Microtia Clinic

The center also established a specialty clinic for microtia, in which children are born with an underdeveloped or missing ear. Professor Lawrence Lustig, M.D., an otolaryngologist, reconstructs the ear canal, and can implant a bone-anchored hearing aid (BAHA) under the hairline. This is particularly helpful in providing children with one functional ear a directional sense of hearing.

Hoffman reconstructs the external ear, using a rib graft. Usually this procedure is performed around age 8, which allows the ribs to grow large enough to create an ear that matches the existing ear in size.

Craniosynostosis Clinic

Another specialty clinic focuses on craniosynostosis, the premature fusing of one or more bones in the skull and face during fetal development, which results in abnormal skull growth.

In partnership with neurosurgeons, Hoffman and Pomerantz work with pediatric neurosurgeons to reshape patients' skulls, often using absorbable plates and screws. Patients with severe facial deformities may benefit from distraction osteogenesis, which gradually stretches out skull and facial bones. This technology can advance the face 20 to 25 mm from the skull, 5 to 10 mm farther than is possible with other techniques. Distraction is often done at a point in the child’s growth that minimizes the need to repeat it, usually age 7 to 9.

"These procedures help a child look as normal as possible, and can also improve their breathing and ability to chew," Hoffman said. "It's a combination of improving appearance and functionality."

Consultations and Referrals

For more information, please contact the Center for Craniofacial Anomalies at (415) 476-2271.

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