This article originally appeared in Pathways, a magazine published for physicians and the community by UMass Memorial Medical Center.

Every day in the United States, more than 600 babies are born with anomalies of the head and face. Surgical and nonsurgical advances, however, have brought new hope to children with both congenital and acquired disorders of the face, mouth or head. In Central Massachusetts, these young patients, their families and their pediatricians have access to comprehensive diagnosis, treatment and support services at UMass Memorial Children's Medical Center.

"We are surgically treating a range of congenital anomalies of the head, neck and face," explained Janice Lalikos, MD, a board-certified plastic and reconstructive surgeon and section head of pediatric plastic surgery at the Children's Medical Center, as well as an associate professor at UMass Medical School. "These include cleft lip and palate, preauricular skin tags and ear deformities - all of which are pretty common. And we also address conditions that are less common, such as craniofacial anomalies associated with various syndromes. Plus, we deal with congenital skin lesions, such as giant nevi and hemangiomas, that are treated surgically, by laser or a combination of both."

Plastic surgeons are also called in on trauma cases through the Emergency Department, particularly for pediatric patients when expertise is required for facial fractures, burns and other cosmetic surgical needs, such as closing a wound to minimize scarring.

Flattened head: an unanticipated side effect of SIDS awareness campaign
Interestingly, Dr. Lalikos is seeing a growing number of young patients with positional plagiocephaly or flattened head - an unanticipated result of the American Academy of Pediatrics' successful "Back to Sleep" campaign. Launched in 1992 to combat Sudden Infant Death Syndrome (SIDS), the campaign has encouraged parents to place children on their backs to sleep. By all accounts, the campaign is a huge success - SIDS rates have plummeted more than 40 percent in the past decade. In that same period, however, the number of infant skull deformities has burgeoned.

"There has been a 1,200 percent increase in flattened head cases," Dr. Lalikos said. "It's rare to operate on these kids; we usually use a prosthetic molding helmet to correct any skull deformity. We also encourage pediatricians to talk to parents about the importance of tummy time while infants are awake and supervised, and alternating the child's head position from left to right each night." Other preventive measures include limiting time spent in car seats or any other type of seat that requires the head to lean back.

"If parents have a colicky child who moves around a lot, chances are that child's head will be perfect," Dr. Lalikos added. 

Surgical advances: "face braces"
When it comes to surgical advances, Dr. Lalikos is particularly excited about the application of distraction osteogenesis to maxillo-facial abnormalities. Distraction osteogenesis originally was an orthopedic technology for gradual limb-lengthening that involved cutting existing bone and inserting a bone distractor. It is now successfully being used as a treatment for children with underdeveloped jaws, cleft lip and palate deformities, those born with unilateral defects, and other facial growth syndromes - including many deformities that previously could not be corrected.

The bone distractor is a titanium device that holds the two pieces of bone less than a millimeter apart and is inserted onto the jaw with pins or screw attachments (upper jaw distraction also utilizes a rigid external halo). The parent tightens the screws regularly to activate the stretching process; this results in osteogenesis, the development of new bone and soft tissue. New bone grows at the rate of about one millimeter per day.

"The process is slow enough to enable the bone to heal, but fast enough so that it doesn't heal closed," Dr. Lalikos explained. "It is like orthodontics for the entire face," she added. Bone distraction requires surgery to implant the device, however, the device can often be removed in an office visit after the desired bone growth is achieved. It takes about six weeks for the new bone to heal and consolidate.

Dr, Lalikos said that bone distraction is a more reliable procedure than bone grafting for large defects, but it takes effort to help the child get through it. "It's not pleasant," she acknowledged, "but you could not get this kind of advancement any other way. We see phenomenal results in just a few months."

Providing psychosocial support
Sensitivity to her young patients' concerns is a hallmark of Dr. Lalikos' practice.
She cited recent research conducted in the United Kingdom that shows family support, social structures and friendships may play a bigger role in the self-esteem of a child with a cleft abnormality than the repaired appearance of the cleft itself.

"While a facial deformity has a big impact on a child's life, it's the child's support system that has the greatest influence on how the child deals with it and how it affects his or her life," she said. "The research showed that when these kids are in a stable home and in a clinic with a team providing therapy that addresses social issues like teasing, many are better adapted than ‘normal' kids. The psychosocial part of facial deformity and corrective treatment is so important to help these kids - and their parents - cope," she said.

To help her patients and their parents in this regard, Dr. Lalikos is committed to making pediatric plastic surgery understandable and accessible. "I think the Internet is probably the biggest nonsurgical advance in my field," she said. "I can direct parents to interactive, helpful and up-to-date sites to help educate them, especially when it comes to rare syndromes. The Internet can open doors for parents, identifying resources they might not be aware of such as an expert in their child's rare disorder.

"I'm more than willing to do telephone screening, or get up-to-date information to parents about resources or support groups," she added. "Accurate information is power. And when parents are empowered, their kids do better."