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