Reconstruction of the skull and facial bones requires extensive knowledge and appreciation of the skeletal architecture. The surgical specialists at the Center for Facial Reconstruction and Restorative Surgery at Cohen Children’s have years of experience reconstructing children’s faces. The center works with patients with severe deficits and functional impairment from trauma and cancer treatment.
At the center, we don’t just treat the aesthetic concerns. We have an interdisciplinary team of surgeons, otolaryngologists, speech and language therapists, social workers, pediatric development specialists and mental health professionals to help your child and your family cope with the changes in physical appearance and emotional status.
At the Center for Facial Reconstruction and Restorative Surgery, we provide advanced treatment for children with a variety of conditions affecting the appearance of the face, including:
Facial fractures can cause severe asymmetries in the face if not properly fixed. Secondary surgery may be necessary to restore balance and positioning of the facial bones. The nasal bone is the most commonly fractured part of the face, usually due to a fall or trauma. In the first two weeks after the injury, the bones can often be reset without making any incisions under anesthesia. Late presenting injuries require osteotomies (re-breaking the bone) to restore the normal bony architecture of your nose.
Zygomaticomaxillary complex (ZMC) fractures are probably the second most common fracture. This fracture usually involves the orbital rim (lower eye socket), cheek bone (zygoma) and may also be associated with an orbital floor fracture. Displaced fractures can cause cheek asymmetry, as well as sunken in appearance to the eye due to the abnormal eye socket anatomy. Unrepaired or inappropriately fixated fracture may require osteotomies (re-breaking the bone) to move the ZMC unit into anatomic position. Numbness of the cheek is quite common with these injuries.
Orbital floor fractures can cause sinking in of the eyeball and even affect the ability to move the eye normally, causing double vision. The orbital floor can be reconstructed using an implant, either titanium or medpor, or a bone graft. The incision can be placed inside the eyelid to avoid visible facial scars.
Mandible fractures are also very common and may require surgery to fixate the mandible in the anatomic position using plates and screws. Frequently arch bars, wires around the teeth, are necessary to help obtain better outcomes, as well as to ensure a functional bite to enable chewing. Infection and poorly healed fractures may require osteotomies, as well as bone grafts to properly heal the fracture.
Irregularities in the shape of the skull from trauma or prior surgery can be disfiguring. The head can appear sunken-in and also leave “soft spots” vulnerable to traumatic brain injury. A cranioplasty may be performed using either implants or bone grafts to effectively contour and protect the skull.
We use the latest 3D computer aided design (CAD/CAM) to create custom implants that will restore your normal anatomy and shape. In addition, we offer the latest in soft tissue reconstruction for severe scarring, hair loss, and burns which may require free tissue flaps or tissue expansion techniques. Our team of craniofacial surgeons, microsurgeons and neurosurgeons will work in conjunction to restore your child to his or her pre-injury state.
Trauma, cancer and birth defects may result in severe facial disfigurement, which requires complex reconstruction of major facial elements. Our team offers the most advanced techniques in facial reconstruction using 3D scan technology to deliver precision and accuracy.
Similar to building a house, the foundation of the face is the most important element in restorative surgery. The facial bones are the foundation upon which the soft tissue reconstruction is later developed. We offer autologous bone grafting, as well as customized implants to re-create facial width and height and serve as a platform for the soft tissue elements.
Tumors may cause defects in the scalp, which can be difficult to reconstruct since the skin in this area tends to be tight. Geometric designs can be used to transfer local tissue into the defect to close it without tension.
The eye socket, also called the orbit, houses the eye and is responsible for its protection, as well as positioning in facial symmetry. The shape of the orbit must be precisely reconstructed or else orbital dystopia (asymmetric eye position) or enopthalmos (sunken eye) may result. Effective tear duct drainage must also be maintained and may require surgical intervention. Our team of ophthalmologic and plastic surgeons works together to effectively analyze and treat defects of the orbit.
Malar (cheek) reconstruction
The cheek is responsible for maintaining facial width. Defects may result from skin cancer removal, Mohs surgery, trauma and burns. Cervicofacial flaps, large face-lift like skin movements, are often necessary to restore the face to its pre-injured state. In severe injuries and burns, often tissue expansion is incorporated to help recruit new skin and soft tissue into the area.
Reconstruction of the jaw bone is often necessary, in cases of congenital defects (hypoplasia) and bone cancers and tumors (i.e., rhabdomyosarcoma, ameloblastoma). Bone grafts from either the rib or leg may be necessary to restore the continuity of the jaw. Dental implant based reconstruction may also be necessary help restore occlusion (bite).
A small, retruded chin reduces the roundness of the lower third of the face and contributes to sagging of the neck. Chin augmentation can be accomplished using either implants or by moving the bone forward. A large chin provides excessive roundness and lower face projection. The bone may be reduced to allow for improved balance in facial features.
Congenital nasal abnormalities, trauma and tumors can severely disfigure the developing nose. Reconstruction of the nose is complex and must address all three tissue layers – mucosa, cartilage/bone and skin. In addition, the nose contains areas of convex details (projection) and area of concavity (flatness). Nasal reconstruction can be achieved often in two to three stages, using local tissues and grafts.
Abdominal wall reconstruction
Muscle and soft tissue can be modified and arranged to help strengthen the abdominal wall and keep the abdominal contents where they anatomically belong. In addition, contour defects and belly button reconstruction can be offered to help improve the shape and look of the abdomen.
Omphalocele / gastroschisis
Malformations of the abdominal wall in-utero can lead to a large defect in the abdominal wall and herniation of the abdominal organs outside of the body. In conjunction with our pediatric surgeons, the abdominal wall can be reconstructed and the organs protected. Tissue expanders and skin grafts are usually necessary in multiple stage operations to effectively restore the anatomy.
Belly button reconstruction
Umbilical hernias in childhood can distort the belly button creating a prominent “outie.” A new belly button can be created using the existing tissues. In the event a hernia is found, our pediatric surgeons will work in conjunction with a plastic surgeon to effectively treat both problems.
Any break in the skin that penetrates to the deep dermis will leave a scar, but we do have techniques that allow us to minimize the amount of scars formed. How much scarring develops is based on many factors, including:
- Tension on the skin when closed
- Anatomic location
- Surgeon’s ability
The plastic surgery specialists at Cohen Children’s are trained in techniques to help minimize scarring by manipulating the tissues to achieve tension free closure and skin edge reversion. Scars take six months to one year to fully mature and sometimes steroid injections and silicone tape may be needed to help soften these scars. Patients who are unhappy with their existing scars may benefit from a scar revision, where the old scar is removed and the tissues closed with plastic surgery techniques.