Why would a child or adolescent need plastic surgery?

You may not associate the phrase “plastic surgery” with children, but pediatric plastic surgeons play a critical role in caring for children and adolescents with a wide range of conditions.

Some of the more minor conditions we treat include ear malformations/deformities, skin tags, moles, “lumps” and “bumps” and head shape anomalies. Concern about head shape is one of the most common reasons we see kids – while the “Safe to Sleep” campaign has reduced the incidence of sudden infant death syndrome, it has led to a dramatic increase in the frequency of abnormal head shapes. Other very common conditions we treat are ear malformations and congenital hand or foot anomalies – often having an extra finger or toe or having multiple digits connected to each other.

What ear anomalies require a pediatric plastic surgeon?

Ear anomalies cover a wide spectrum, from being prominent on the mild end to completely absent on the severe end. The plastic surgery depends on the condition – prominent ears can be molded in infancy or surgically treated (otoplasty or ‘ear pinning’) at an older age, while an absent ear may require a more involved surgery using cartilage.

What are some of the more complex conditions in children that require plastic surgery?

These include craniosynostosis, in which the bones of the skull fuse prematurely, cleft lip and palate, breast anomalies, and jaw problems or malocclusion.

What can be done for a malocclusion or “bad bite”?

The jaws can be moved surgically to a better position. There are three common reasons a child may be a candidate for jaw surgery:

1. Developmental: The upper and lower jaws grow in such a way that they don’t meet properly or just aren’t in the right place. This can lead to difficulty chewing, pain in the jaw joint and/or muscles, unfavorable appearance and sleep apnea.
2. Malocclusion caused by a medical syndrome or trauma: The most common syndrome associated with abnormal jaw growth is cleft lip and palate. Many patients with clefts ultimately require jaw surgery. Injuries to the jaw can also heal in poor position or disrupt future growth.
3. Breathing issues: This can occur in patients of any age but is most common in infants or adults. In infants, breathing issues that may require jaw surgery are typically caused by the lower jaw being underdeveloped. In adults, weight gain is often involved, especially if the patient has a relatively small jaw. Soft tissue can crowd the throat, narrowing the airway and ultimately cause obstructive sleep apnea. This can be treated by pulling the jaws forward, which takes the soft tissue of the throat with it, opening the airway. This is also usually a cosmetically favorable change.

Regardless of the complexity of a child’s condition, experienced multidisciplinary teams are equipped to provide personalized care using innovative treatment options.

Dr. John Smetona is a pediatric plastic surgeon at Advocate Children’s Hospital.

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