Facial Deformities

Facial Deformities


MicrotiaMicrotia means a small, abnormally shaped or absent external ear. It can occur on one side of the head (unilateral) or on both sides (bilateral). Microtia occurs once in every 4,500 births in the general population; bilateral microtia occurs once in every 18,000 birth. The causes of microtia are difficult to define. Some theories point toward a decrease in blood supply to the developing ear in utero. Others involve certain medications taken by the mother during pregnancy, such as Accutane, Thalidomide, and retinoic acid. Environmental factors have also been considered.


Cleft LipCleft lip (CL) can be an isolated event or can be found in conjunction with a cleft palate (CP). In general, the condition refers to a separation of the parts or segments of the lip or roof of the mouth, which are usually joined together during the early weeks of development of an unborn child. Cleft palate is an opening in the roof of the mouth. It occurs when the two sides of the palate do not fuse as the unborn baby develops. Cleft deformities often occur without any previous family history. Among the factors that are known to increase the risk of a child’s developing CLP are smoking or drinking by the mother during pregnancy. Repair of these problems is not only important medically, but also cosmetically and emotionally, since the child’s speech and physical appearance is impaired, which can prevent acceptance by peers.
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HEMIFACIAL MICROSOMIAHemifacial microsomia (HFM) is a condition that affects bone, muscle, fat and nerves of the face. The deformities in HFM are on a spectrum from a mild presentation with slight asymmetry to severe absence of facial structures. This condition is progressive and becomes more apparent as the individual matures. HFM is the second most common facial deformity. It occurs in approximately 1 in every 5,600 births. The cause is unknown and there is no gender predilection.
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Vascular BirthmarksChildren may be born with concentrated areas of hyperpigmentation that appear as red spots on the face or neck. Often, these defects present at birth and fade as the child ages, but severe hemangiomas may require surgery with skin grafting techniques. Vascular birthmarks are generally classified as either hemangiomas or vascular malformations.


Pigmented spots (nevi), while part of the normal aging process, are not common in children. Occasionally congenital pigmented nevi are important to note because they are considered to have a small chance of malignant degeneration. Small nevi can be removed without much difficulty in just one excision procedure. However, larger congenital pigmented nevi pose a demanding reconstructive challenge and should be treated by experienced pediatric plastic surgeons, such as those of The Little Baby Face Foundation. The removal of a very large nevi may require multiple stages or placement of tissue expanders to create extra skin. In cases where the hairy nevus is located on the nose, ears or eyelids removal may include a skin graft from another part of the body.


Hearing RestorationChildren born with ear deformities often suffer hearing loss due to the absence of their ear canals and/or middle ear structures. Children born with both ears deformed need immediate attention and hearing rehabilitation in order to avoid the devastating effects of early deafness on their growth and development. Combining external ear reconstruction with functional restoration of hearing provides affected children with a significant cosmetic improvement and recovery of useful hearing, enabling them to mingle with their peers, participate in activities, learn and compete in the classroom, and eventually in the workplace.
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Facial PalsyA child with facial palsy cannot smile or laugh, or express any facial movement. The act of facial motion starts in the brain and travels through the facial nerves to the muscles in the face. The coordinated activity of this nerve and these muscles cause motions such as smiling, blinking, frowning, and a full range of normal facial motions. Facial paralysis can be caused in children by the failure of the brainstem nuclei to develop (a condition known as Moebius Syndrome), a trauma to the nucleus of the facial nerve, and tumors or trauma to the facial nerve. A variety of medical techniques, coupled with cosmetically placed incisions, can truly restore a smile to a child’s face. To achieve facial balance and reanimation, surgeons are employing eyelid weights, local muscle slings, nerve grafts and microvascular muscle transplants.
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EAR RECONSTRUCTION / OTOPLASTYMany children are born with protruding or disfigured ears, which may become a source of painful emotional trauma as the child tries to “fit in” with his or her peers. Reconstructive ear surgery can improve the shape, position or proportion of the ear, as well as increase the child’s self-esteem significantly. Ear reconstruction — commonly referred to as otoplasty — improves the shape, position or proportion of the ear. The surgery can correct a congenital birth defect in the ear structure that becomes more apparent as the child develops, or it can treat misshapen ears caused by injury.


This is defined as premature fusion or growth arrest at one or more of the cranial sutures, most commonly occurs sporadically as an isolated defect caused by a random mutation of a particular chromosone. The cause of this mutation is not fully understood, but it appears that the mutation is not a result of something either parent does or fails to do. However, the defective gene in your child may be passed on to his/her offspring. Genetic testing of your child is recommended. Syndromes most frequently associated with craniosynostosis include Apert, Crouzon, Pfeiffer, Carpenter, and Saethre-Chotzen.