Pediatric plastic surgery
Encyclopedia
Pediatric plastic surgery is plastic surgery
performed on children. Its procedures are most often conducted for reconstructive or cosmetic purposes. In children, this line is often blurred, as many congenital deformities impair physical function as well as aesthetics.
Surgery
is defined as treating injuries or conditions with operative instrumental treatment. Plastic is a derivative of the Greek word plastikos, which means 'to build up' or 'to take form.' It is a logical prefix, as parts of the body are remade or reformed during most reconstructive and cosmetic surgical procedures. Children make up roughly 3% of all Plastic Surgery procedures, and the majority of these procedures correct a congenital deformity.
Cosmetic plastic surgery is defined as a surgical procedure undertaken to improve the physical appearance and self-esteem of a patient. As these procedures are usually elective, they are generally not covered by insurance.
Reconstructive surgery on the other hand (the procedures most children have done), is performed on abnormal structures of the body that are the result of “congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.” While reconstructive surgery is most often undertaken to regain normal motor function or prevent current or future health problems, aesthetics are also considered by the surgical team.
Out of all procedures, nose reshaping generally has the most cases on an annual basis (4,313 procedures in 1996). However, children make up only 9% of the total caseload for all nose reshaping. On the opposite end of the spectrum, children requiring ear surgery accounted for 2,470 procedures in 1996, a total of 34% of all total ear surgeries.
While many of these procedures are done for purely cosmetic benefit, many plastic surgeons work on these features (giving them a more normal appearance), while performing a surgery to improve function as the result of a congenital deformity.
Common conditions involving team treatment include:
Children's Hospital Los Angeles - Division Head: Mark Urata, DDS, MD
Children's Hospital Boston
– Chief of Surgery : John G. Meara, MD, DMD, MBA, FACS, FRACS
Children's Hospital of Philadelphia
– Director: Scott P. Bartlett, MD
Texas Children’s Hospital, Houston
– Chief of Service: Samuel Stal, MD
The Children's Hospital, Aurora, Colorado
St. Louis Children's Hospital, St. Louis, MO
In addition to those offering comprehensive departments, many other pediatric hospitals also treat plastic surgery cases within the department of surgery.
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
performed on children. Its procedures are most often conducted for reconstructive or cosmetic purposes. In children, this line is often blurred, as many congenital deformities impair physical function as well as aesthetics.
Surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
is defined as treating injuries or conditions with operative instrumental treatment. Plastic is a derivative of the Greek word plastikos, which means 'to build up' or 'to take form.' It is a logical prefix, as parts of the body are remade or reformed during most reconstructive and cosmetic surgical procedures. Children make up roughly 3% of all Plastic Surgery procedures, and the majority of these procedures correct a congenital deformity.
Cosmetic plastic surgery is defined as a surgical procedure undertaken to improve the physical appearance and self-esteem of a patient. As these procedures are usually elective, they are generally not covered by insurance.
Reconstructive surgery on the other hand (the procedures most children have done), is performed on abnormal structures of the body that are the result of “congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.” While reconstructive surgery is most often undertaken to regain normal motor function or prevent current or future health problems, aesthetics are also considered by the surgical team.
Reconstructive Plastic Surgery
Several of the most common congenital birth defects can be treated by a plastic surgeon operating as an individual, or as a part of a multi-disciplinary team. The most common pediatric birth defects requiring plastic surgeon involvement include:- Cleft lip and/or palate - Worldwide, clefts are estimated to affect 1 in every 700-1000 live births. Roughly 25% of cleft lip and palate cases are inherited from parents, with the other 75% believed to be the cause of a combination of lifestyle and chance factors.
- SyndactylySyndactylySyndactyly is a condition wherein two or more digits are fused together. It occurs normally in some mammals, such as the siamang and kangaroo, but is an unusual condition in humans.-Classification:...
/ PolydactylyPolydactylyPolydactyly or polydactylism , also known as hyperdactyly, is a congenital physical anomaly in humans, dogs, and cats having supernumerary fingers or toes....
– The most common of congenital malformations affecting limbs, it is believed that Syndactyly, the failure of fingers or toes to differentiate into unique digits, affects 1 in every 2,000 – 3,000 live births. Polydactyly is the presence of extra fingers or toes at birth, and is believed to affect somewhere around 2 out of every 1,000 live births. However, it is believed that many cases are so minor that they are taken care of shortly after birth and not reported, so actual statistics may be higher. - Positional PlagiocephalyPlagiocephalyPlagiocephaly is a condition characterized by an asymmetrical distortion of the skull.-Causes:It is a common finding at birth and may be the result of a restrictive intrauterine environment. If there is premature union of skull bones, this is more properly called craniosynostosis...
– IN 1992, to decrease the incidence of SIDS, the American Academy of Pediatrics initiated the “Back to Sleep” campaign, which recommended that babies be put to sleep on their backs. While this almost halved the number of SIDS deaths, the campaign appeared to also help raise plagiocephaly incidence fivefold, to roughly one in sixty live births. Plagiocephaly is simply the flattening of one area of the skull, generally one babies tend to favor as they lie. While treatment is often as simply as repositioning the baby during sleep, in more pronounced cases helmet therapy may be put to use. In most cases, plagiocephaly is quite minor and easily resolved, with many more pediatric plastic surgeons becoming familiar with helmet therapy for more advanced cases. - CraniosynostosisCraniosynostosisCraniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by ossification, thereby changing the growth pattern of the skull...
– Much less common, but potentially much more serious than plagiocephalyPlagiocephalyPlagiocephaly is a condition characterized by an asymmetrical distortion of the skull.-Causes:It is a common finding at birth and may be the result of a restrictive intrauterine environment. If there is premature union of skull bones, this is more properly called craniosynostosis...
is craniosynostosisCraniosynostosisCraniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by ossification, thereby changing the growth pattern of the skull...
. CraniosynostosisCraniosynostosisCraniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by ossification, thereby changing the growth pattern of the skull...
occurs when one or more of the sutures in skull fuse prematurely. This fusion often requires surgical intervention to reconstruct the skull (see craniofacial surgeryCraniofacial surgeryCraniofacial surgery is a surgical subspecialty of maxillofacial surgery, plastic surgery, and ENT that deals with congenital and acquired deformities of the skull, face, and jaws. Although craniofacial treatment often involves manipulation of bone, craniofacial surgery is not tissue-specific,...
) to give it a more natural shape. It is believed that craniosynostosis occurs in 1 out of 1,800 to 2,200 live births, and is often a side effect of an associated syndrome.
Cosmetic Plastic Surgery
While the majority of pediatric plastic surgery procedures done are reconstructive; there are those performed for cosmetic purposes. The most common procedures done for cosmetic benefit in children include:- Breast AugmentationBreast augmentationBreast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...
- Male Breast Reduction
- Ear Surgery as a result of microtiaMicrotiaMicrotia, also called microtia-anotia, is a congenital deformity where the pinna is very small and underdeveloped or absent . It can be unilateral or bilateral . It occurs in 1 out of about 8,000–10,000 births. In unilateral microtia, the right ear is most commonly affected...
- RhinoplastyRhinoplastyRhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
Out of all procedures, nose reshaping generally has the most cases on an annual basis (4,313 procedures in 1996). However, children make up only 9% of the total caseload for all nose reshaping. On the opposite end of the spectrum, children requiring ear surgery accounted for 2,470 procedures in 1996, a total of 34% of all total ear surgeries.
While many of these procedures are done for purely cosmetic benefit, many plastic surgeons work on these features (giving them a more normal appearance), while performing a surgery to improve function as the result of a congenital deformity.
Multi-Disciplinary Emphasis
With the unique challenges created in the field of plastic surgery, an increasingly popular trend has been to utilize the multi-disciplinary team approach in treatment.Common conditions involving team treatment include:
- Breast problems - Includes gynecomastiaGynecomastiaGynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"...
(male breast development), macromastia (excessively large breasts), tuberous defects, and breast asymmetry. Often, not only do children with breast conditions suffer from physical problems, but psychological side effects as well. With this knowledge, current multi-disciplinary clinics have arisen including specialists from plastic surgery, nutrition, adolescent medicine, psychology, gynecology, and social work.
- Head, Neck, and Skullbase Tumors – Includes angiofibromaNasopharyngeal angiofibromaNasopharyngeal angiofibroma is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males...
, desmoid tumorDesmoid tumorAggressive fibromatosis is a rare condition marked by the presence of desmoid tumors, which are benign, slow-growing tumors without any metastatic potential. However, Aggressive Fibromatosis is locally aggressive. Despite their benign nature, they can damage nearby structures causing organ...
s, fibrosarcomaFibrosarcomaFibrosarcoma is a malignant tumor derived from fibrous connective tissue and characterized by immature proliferating fibroblasts or undifferentiated anaplastic spindle cells.Usually in males ages 30 to 40. Originates in fibrous tissues of the bone. Invades long or flat bones such as femur, tibia,...
s, hemangiomaHemangiomaA hemangioma of infancy is a benign self-involuting tumor of endothelial cells, the cells that line blood vessels. It usually appears during the first weeks of life and sometimes resolves by age 10. In more severe case hemangioma may have permanency, if not treated by a physician...
s, lymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
s and lymphatic malformations, and neuroblastomaNeuroblastomaNeuroblastoma is the most common extracranial solid cancer in childhood and the most common cancer in infancy, with an annual incidence of about 650 cases per year in the US , and 100 cases per year in the UK . Close to 50 percent of neuroblastoma cases occur in children younger than two years old...
. While the bulk of procedures may be left up to neurosurgeons, otolaryngology, and maxillofacial surgery, a multidisaplinary approach is also crucial to minimize scars and maintain a somewhat normal shape and function.
- Cleft lip and palate – In cleft lip and palate cases, not are there only hampering physical side effects manifested in the under developed lip and palate, there are also a host of other potential complications. For this reason, CLP children are cared for by a team that may include plastic surgeons or oral and maxillofacial surgeons, speech pathologists, audiologists, densits, orthodontists, and genetics professionals if there is an associated syndrome.
- Craniofacial anomalies - Includes craniosynostosisCraniosynostosisCraniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by ossification, thereby changing the growth pattern of the skull...
, plagiocephalyPlagiocephalyPlagiocephaly is a condition characterized by an asymmetrical distortion of the skull.-Causes:It is a common finding at birth and may be the result of a restrictive intrauterine environment. If there is premature union of skull bones, this is more properly called craniosynostosis...
, and syndromes associated with these defects. In cases of craniosynostosis where surgical intervention is necessary, the involvement of a team of multi-disciplinary professionals is of utmost importance. Team members often come from departments of plastic surgery, oral and maxillofacial surgery, neurosurgery, audiology, dentistry, orthodontics, and speech and language pathologySpeech and language pathologySpeech-Language Pathology specializes in communication disorders.The main components of speech production include: phonation, the process of sound production; resonance, opening and closing of the vocal folds; intonation, the variation of pitch; and voice, including aeromechanical components of...
. These professionals often assist not only in operational procedures, but in developing coordinated care plans for the child throughout their life. - Vascular anomalies – vascular malformations, hemangiomaHemangiomaA hemangioma of infancy is a benign self-involuting tumor of endothelial cells, the cells that line blood vessels. It usually appears during the first weeks of life and sometimes resolves by age 10. In more severe case hemangioma may have permanency, if not treated by a physician...
s, and rare vascular tumors. Not only do vascular anomalies have often prominent interior bodily effects; they manifest themselves physically as well. For this reason, the involvement of multiple specialties in coordinating care is of utmost importance. Specialists involve in vascular anomalies and hemangioma care often hail from the disciplines of general surgery, vascular anomalies research, plastic surgery, dermatology, cardiology, hematology/oncology, neurology/neurosurgery, maxillofacial surgery, and otolaryngology. The child needs treatment not only to minimize the physical side effects of a hemangioma or vascular anomalies, but also help in finding out why the tumor is present (if it is in fact a tumor), and developing a course of treatment if necessary.
Children’s Hospitals with Dedicated Plastic Surgery Departments
With the advent of pediatric plastic surgery as a legitimate subspecialty, many children’s hospitals have begun to add comprehensive Plastic Surgery Departments to their hospitals programs. Such programs include:Children's Hospital Los Angeles - Division Head: Mark Urata, DDS, MD
Children's Hospital Boston
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
– Chief of Surgery : John G. Meara, MD, DMD, MBA, FACS, FRACS
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
The Children's Hospital of Philadelphia is one of the largest and oldest children's hospitals in the world. CHOP has been ranked as the best children's hospital in the United States by U.S. News & World Report and Parents Magazine in recent years. As of 2008, it was ranked #1 in the nation for...
– Director: Scott P. Bartlett, MD
Texas Children’s Hospital, Houston
Texas Children's Hospital
Texas Children's Hospital is a pediatric hospital located in the Texas Medical Center in Houston, Texas.With 639 licensed beds and 465 beds in operation, Texas Children's is the largest children's hospital in the United States and is affiliated with the Baylor College of Medicine as that...
– Chief of Service: Samuel Stal, MD
The Children's Hospital, Aurora, Colorado
St. Louis Children's Hospital, St. Louis, MO
In addition to those offering comprehensive departments, many other pediatric hospitals also treat plastic surgery cases within the department of surgery.