Face, head & neck

Cleft Lip and Palate

Cranio-Facial anomalies

  • Facial Clefts
  • Cranio-Synostosis
  • Hypertelorbitism

Face and Head :

Cleft lip and cleft palate: Defects can be individual, i.e. either cleft lip or cleft palate or combined cleft lip and palate with alveolus. Can be one side (unilateral) or both side (Bilateral).

Cleft lip– A slit or gap in lip from birth. Defect may be like a slight notch to a big gap. A child with cleft lip looks ugly and there may be speech problems also if gap is very big.

Treatment: Treatment is operation- repair of Lip. Treatment at an early age (If possible within one month of age) gives better result if children are normal. But it can be repaired at any age.

If gap is wide and there are defects in gum and palate, deformity may arise after proper repair also. In that case further plastic surgery will solve the problem.

 Cleft palate– A slit or gap in Palate from birth. Defect may be like a slight notch to a big gap. Cleft palate child suffer with feeding problem and thus malnourished, frequent ear infections, frequent respiratory tract infections like pneumonia which may be life threatening, in later life speech problem – they can’t pronounced the words properly, their speech is not understandable. A child with cleft lip and palate can’t go to school properly as his/her speech is not understandable. They are socially neglected. They can’t get married properly.

Treatment: Operative treatment- Palatoplasty (Repair of Palate).  Ideal time of repair is 8-10 month of age, if child is suffer with any medical condition like fever, pneumonia, etc. it may be delayed but must be done within 18 months of life otherwise he/she can’t speak properly though it can be repaired in later life also. After repairing there can develop a hole in palate which can be cured spontaneously, if not cured it can be repaired after 6-12moths of operation or later.


Alveolus (Gum) :Defects in alveolus causes dental problems. Alveolar defects can be repaired with bone grafts at the age of 7 years.

Facial clefts: A slit or gap in lip from birth which may involve wide area of face including nose, eye. Defect may be like a slight notch to a big gap. A child with facial cleft looks uglier than simple cleft lip and there may be speech problems also if the gap is very big.

Treatment: Treatment is operation- repair of the defects. Treatment at an early age (If possible within one month of age) gives better result if the child has no other diseases. But at any age it can be repaired. Sometimes it needs multiple operations.

Before and after care of Cleft lip, Palate, Facial cleft Surgery:

Before Surgery: 

  • Child should feed normally.
  • Breast feeding.
  • No feeder.

If needed, Spoon feeding or feeding by dropper or Special feeder.

For cleft palate child, they should  feed in upright semi tingling position that is 45° angle position with floor.

Child should be careful about cold, respiratory tract infection, pneumonia, etc which may endogenous life.

After Surgery:

Patient should take regular bath and clean the operation site regularly as per surgeon’s advice.

Palate may suffer with oral pain and difficulty in feeding which will cure spontaneously. They should eat liquid/semisolid cold diet for 4-8 weeks.

Hypertelorbitism: Both eyes are more apart and widened nasal root.

Treatment: Surgery, preferably within one year of age by multidisciplinary team approach including neurosurgeon, eye surgeon, pediatric surgeon, orthopedic surgeon etc.

Craniosynostosis – Congenital deformity of head.

Premature fusion of one or more sutures (joints) of cranial (Skull) bones is called Craniosynostosis.   It causes deformity in the shape of head as well as small head also which may  results in increased intracranial pressure (symptoms- vomiting, visual disturbance, bulging anterior fontanel, altered mental status, papilledema, headache, etc), obstructive sleep apnea (symptoms- difficulty in breathing, snoring, day-time sleepiness and perspiration), neurobehavioural impairment includes problems with attention and planning, processing speed, visual spatial skills, language, reading and spelling.  A decreased IQ may also be part of the problems. 

Treatment: Surgical intervention between 6-12 months of age by multidisciplinary approach including neurosurgeons.


 Nasal Deformities:  

  • Nasal deformity – There are various types of nasal deformity that may be congenital or acquired (Accidental/Traumatic, due to disease) like Saddle nose, Bifid nose, nasal deformity with cleft lip, traumatic deformity,  etc.  The procedure of correction of nasal deformity is called Rhinoplasty.  In other word, rhinoplasty means nose reconstruction or reshaping that creates a more attractive and proportioned nose by changing its size, slope or shape.

Why Nasal Reconstruction (Rhinoplasty)?

  • You have congenital deformity of nose, like saddle nose
  • You have a large, wide and/or drooping nose
  • Your nose is out of balance with the rest of your face
  • An injury caused damage or a crooked shape
  • You have breathing problems as a result of a trauma, an accident or birth defect.

Results:

  • Balance the proportion of both nostril.
  • Create a beautifully shaped nose
  • Balance the proportions of your face
  • Straighten crooked or broken noses
  • Improve breathing capability and restore proper function

Timing of Rhinoplasty:

There is no fixed time. It depends upon the type of nasal deformity. Sometimes it can be performed during the lip repair of cleft lip patients.

How nasal reconstruction performed?

Your surgeon will make an incision, usually placed within the nostril to the framework of the nose. Cartilage is then sculpted away to reduce the size or shape. If the opposite result is desired, tissue may be added to increase the size of the nose. Nose reconstruction may need silicon implants or cartilage from patient’s ear or chest depending upon the defect.  The septum may be trimmed to correct droopiness or may be realigned to correct breathing problems.

A rhinoplasty procedure can take from one to three hours, depending on the complexity of the procedure. This surgery is done on an outpatient basis with general anesthesia. Sometimes patient may need admission in hospital.  Because safety is our first concern, we always work with board-certified anesthesiologists to ensure that your surgery is as safe as possible. Following your surgery, you will be able to rest in the comfort of your own home.

Recovery & Aftercare:    

  • Rhinoplasty patients may experience some degree of bruising that progressively improves over two to three weeks
  • A splint will be placed on the outside of the nose and possibly on the inside as well. Both types of splints are used to protect the temporarily delicate, nasal structures.
  • Bed rest on the day of surgery is recommended.
  • Limit activity for the next two days following surgery.
  • Avoid strenuous activities for about four to six weeks.
  • Return to work in about one to three weeks.

Additional Procedures:

Cheek and/or chin implants may be recommended to enhance the results of your rhinoplasty. Please discuss these additional options with your doctor.

Ear : 

  • Congenital ear defects –deformity in ear lobule, Microtia, etc.
  • In some cases these deformities can cause hearing loss, and they can also be embarrassing for children, so early intervention is important.
  • Congenital Ear deformity may be-
  1. Complete absence of the external ear and meatus.
  2. Complete or incomplete absence of the external ear.
  3. Ectopic ear
  4. Supernumerary Tags
  5. Preauricular sinus
  6. Prominent ears
  7. Faun ear or incomplete folding of helix or or outer rim of the ear
  8. Abnormally small ear
  9. Abnormally large ear
  10. Asymmetrical ear
  11. Large lobule
  12. Adherent lobule

( Focur HO,  Canadian Medical Association Journal, July 1940, p 26)

There are two types of congenital ear deformity:

Microtia – This is abnormal growth of the external ear. May be associated with hearing loss. Microtia can range in severity from a minor ear fold to a marked absence of ear development, where a small tag of skin and cartilage are the only signs of an external ear.

Atresia of ear– Complete absence of the external ear canal, which is almost always accompanied by abnormalities of the middle ear bones, as well as the external ear.

Children can suffer from one of these types of congenital ear deformities, or both may be present at the same time. Also, these two conditions can occur in one or both ears. Congenital ear deformities can be associated with other syndromes like Treacher Syndrome, Goldenhar Syndrome, etc.

Diagnosis: Clinical

Investigations:

  1. Hearing evaluation
  2. Multi-dimensional X-ray
  3. CT Scan
  4. Others like hemogram, etc for anesthetic fitness before operation.

Treatment: Ear reconstruction according to type of deformity with or without hearing Aid.

Neck Deformity:

Torticollis (Wryneck or twisted neck):

 It is a postural deformity of head and neck detected at birth or shortly after birth, primarily resulting from unilateral fibrosis & shortening of the Sternocleidomastoid muscle (Anterior neck muscle). The head is therefore rotated away from & tilted toward the involved sternocleidomastoid muscle. History, physical examination & clinical progression can do the diagnosis but in some cases ocular, neurological evaluation and radiological investigation of cervical spine is necessary.  

 

Treatment:  Treatment depends upon the age of patient. Patient of below 1 year of age, treatment is conservative – Physiotherapy and above one year of age – treatment is surgery.