Children born with craniofacial differences may have changes in the bones and soft tissues of the face, eyes, ears, and jaws. These conditions vary widely in severity, but many can be improved with reconstructive surgery. Care is best planned through a multidisciplinary team (MDT), as many children require coordinated treatment from plastic surgeons, otorhinolaryngologists, maxillofacial surgeons, ophthalmologists, speech therapists, dentists, and orthodontists. At the Queensland Children’s Hospital, a dedicated craniofacial multidisciplinary clinic provides coordinated assessment. While children can also be seen and treated privately, it is still valuable to have an MDT review at the Queensland Children’s Hospital.
Examples of Craniofacial Conditions Treated
There are a wide range of craniofacial conditions that we treat. Many are congenital in nature, present from birth, while others may arise later in the paediatric age group following trauma, infection, or oncologic surgery. Treatment is often staged throughout a child’s development from infancy through to early adulthood, as different functional and aesthetic concerns become apparent at various ages.
Some of the common conditions we manage include:
Craniofacial Microsomia
Craniofacial microsomia is a common congenital condition where one side of the face is underdeveloped. This may involve the ear, jaw, soft tissues of the cheek, and sometimes the eye or facial nerve. Other causes of facial asymmetry include hemifacial hypertrophy or isolated mandibular or zygomatic deficiency.
Surgical options considered:
- Repair of macrostomia: Closure of a macrostomia (widened corner of the mouth) is often carried in infancy, particularly if it is severe, to aid with feeding.
- Mandibular distraction osteogenesis: A technique using an internal or external device to gradually lengthen the lower jaw. This helps improve facial balance, airway function, and dental alignment.
- Rib grafts or bone grafts: Used to reconstruct segments of the mandible when there is a significant deficiency (i.e. missing or underdeveloped mandibular condyle).
- Free tissue transfer: Vascularised bone flaps (e.g., fibula flaps) are occasionally required for severe mandibular absence.
- Facial implants or bone grafts: To augment the cheekbones, jawline, or chin for improved symmetry.
- Soft-tissue augmentation: Fat grafting can improve soft-tissue fullness and contour.
Craniofacial Clefts
Facial clefts extend beyond typical cleft lip and palate patterns and may involve the eyelids, cheeks, nose, and jaw. These rare clefts that are also termed Tessier clefts and involve both bone and soft tissues.
Surgical options considered:
- Soft-tissue cleft repairs: Closing the skin, muscle, and mucosal defects to restore normal facial contours.
- Bone grafting: Reconstruction of defects in the cheekbone, orbital rim, or maxilla.
- Maxillary and mandibular osteotomies: Used later in childhood or adolescence to restore normal alignment and bite relationships.
- Facial augmentation: Implants or grafts to improve symmetry after primary repairs.
Maxillofacial Dysplasias
Maxillofacial dysplasias are a group of developmental disorders affecting the jaw and facial bones, often leading to symptoms like facial asymmetry, bone enlargement, and dental abnormalities. These can have function impacts on breathing, eating, and speech. Examples include maxillary hypoplasia, mandibular overgrowth, vertical maxillary excess, and fibrous dysplasia.
Surgical options considered:
- Maxillary osteotomies: Used to move the upper jaw forward, upward, or downward to correct midface deficiency or malocclusion.
- Mandibular osteotomies: Performed to correct underbite, overbite, or asymmetry.
- Debulking or resection surgery: Used to reduce areas of localised overgrowth and restore facial proportions or facial symmetry.
- Skeletal augmentation: Use of bone graft or implants to reconstruct areas of deficiency.
Microphthalmia
Microphthalmia refers to an abnormally small eye. It may be accompanied by an underdeveloped orbit, soft-tissue deficiency, and eyelid abnormalities.
Surgical options considered:
- Soft-tissue expansion: Use of conformers or expanders to enlarge the socket as the child grows.
- Orbital bone reconstruction: Bone grafts or implants used to increase orbital volume or support prosthetic eyes.
- Eyelid reconstruction: Repairs for eyelid coloboma or soft-tissue deficiency.
Orbital Dystopia and Other Orbital Dysplasias
These conditions involve abnormal position or shape of the bony orbit, which can affect binocular vision and facial symmetry. Examples include vertical orbital dystopia, hypertelorism, and orbital rim deficiency.
Surgical options considered:
- Box osteotomies: Controlled cuts in the facial bones allowing repositioning of the orbits for improved symmetry or spacing.
- Orbital rim augmentation: Using bone grafts or implants to reshape the orbit.
Congenital Ear Anomalies
A variety of congenital ear differences can affect children, ranging from mild shape variations to more complex structural abnormalities. These include prominent ears, cryptotia (where the upper ear is partially buried beneath the scalp), constricted ears (cupped ears), Stahl’s ear (an extra cartilage fold that gives the ear a pointed shape), lop ear deformity (where the upper part of the ear folds over), and cleft ear lobules.
Management depends on the specific deformity and its severity. Treatment options include otoplasty, (which reshapes the cartilage to create natural folds and improve ear position). For conditions like cryptotia, local flaps are often required to reconstruct the superior part of the ear after it is released.
Hemifacial Atrophy
Hemifacial atrophy (also known as Parry–Romberg Syndrome) is a progressive condition involving loss of fat, muscle, and sometimes bone on one side of the face.
Surgical options considered:
- Fat grafting: Often performed in stages to restore soft-tissue volume.
- Bone grafts or facial implants: Used to correct bony asymmetry if present.
- Jaw surgery: Occasionally required if the mandible becomes significantly underdeveloped to correct facial asymmetry.
