Pediatric Reconstruction

Depending on the condition, the child may be able to have surgery within his or her first year of life. In some cases, it may be better to wait longer. And in other cases, a series of surgeries may be needed. 

Craniofacial Conditions and Syndromes

Craniofacial microsomia, sometimes known as hemifacial microsomia or otomandibular dysostosis, among other names, is a condition that causes children to be born with underdeveloped or small parts of the face, most commonly the jaw and ear (which may be called microtia). After cleft lips and palates, this is the most common facial birth defect.
Some children are born with Pierre Robin Sequence, which may also be called Pierre Robin Syndrome or Pierre Robin Malformation. It is characterized by a jaw that is too small, a cleft palate, retraction of the tongue and upper airway obstruction. As with other types of facial conditions, the jaw and cleft palate can be repaired with surgery.

Obstetric brachial plexus injury

In infants, brachial plexus injury most often occurs during an abnormal or difficult birth, causing damage to the brachial plexus nerves (shoulder dystosia). Depending on the injury, a baby may be diagnosed with different kinds of palsy, including Erb’s palsy and Klumpke’s palsy. In about one in 10 cases, the child will need some kind of surgery to repair the nerves. Generally, surgeons recommend that the surgery be done when children are between the ages of four and nine months.
Jaw surgeries: For a child born with a small jaw or receding chin, a reconstructive surgeon can correct the condition through several different kinds of surgery. Most commonly, the reconstructive surgeon will cut the jawbone, a procedure known as an osteotomy, to reposition it using titanium screws and plates, which eliminates the need for wiring the teeth together.
Another technique, distraction osteogenesis, splits the jawbone and then moves the jawbone slowly by inserting a screw either inside the mouth or outside and turning it periodically over a few weeks. The advantage of the distraction technique is that it simultaneously increases bone length and the volume of the soft tissue around the bones.
The plastic surgeon may also create a new jawbone structure using bone grafts from the ribs, hips, or skull, or alloplastic grafts, which are created from synthetic materials.
Ear surgeries: Reconstructing the ear to make it a normal size will likely require three surgeries over a period of time. In some cases, a child may need an artificial or prosthetic ear, which also requires several surgeries.
Repairing the ear can take anywhere from two to four surgeries. The reconstructive surgeon may recommend using the child’s ribs to reconstruct the ear or may decide that an alloplast—synthetic material—would be best.