Mediclinic boasts world-class paediatric craniofacial surgery team

Posted on 19 Jul 2022

A Gauteng-based multidisciplinary team led by Professor Tim Christofides provides expert care for children with abnormalities of the bones and soft tissues of the head and face. 

Children with craniofacial abnormalities will be affected in a number of ways. Other than the visible deformities that require surgery, conditions like cleft lip and palate may affect how they chew, swallow, speak, and hear, among other serious problems.  

Most craniofacial and cleft lip and palate anomalies are congenital and can be corrected with craniofacial surgery – a highly specialised field that requires a multidisciplinary approach with input from plastic surgeons, neurosurgeons, maxillofacial surgeons as well as other specialities.  

Professor Tim Christofides of Mediclinic Morningside, president of the Association of Plastic and Reconstructive Surgeons of South Africa (APRSSA), has more than two decades of experience in the field of craniofacial reconstructive surgery.  

He leads a multidisciplinary team, including Dr Sheree Koonin, a plastic and reconstructive surgeon at Mediclinic Sandton, who recently joined them. Dr Koonin, who has a keen interest in this field of plastic surgery, says:  “I’m privileged to have the opportunity be part of this team, operating with and being mentored by leading experts, professors and world-renowned surgeons.” 

Types of abnormalities
As Professor Christofides explains, craniofacial abnormalities can be divided into several groups, according to what the causative problem is. Most of the required surgeries call for a multidisciplinary team to ensure the best patient outcomes:

Craniosynostosis: Abnormal head shape and size
This condition results from abnormalities in the sutures (growth areas) of the skull bones. When these growth areas close too early they don’t allow growth to take place in certain places in the skull. The other growth areas then take over, which results in overgrowth of the skull in other areas.  

When more than one suture is involved, the skull does not grow in many areas. This could result in a small skull and compression of the brain. If the brain is compressed, it cannot grow to its full potential. In these cases the head shape is abnormal and could be long, tall or “crooked”, depending on which growth area is affected. 

Another type of “crooked” head is known as a deformational abnormality. This isn’t a result of an abnormal growth plate in the skull. It’s caused by constant pressure on one side of the head, which then pushes the skull into a strange shape. This pressure mostly occurs in the uterus before the child is born. In these cases, the abnormal shape can be treated with correct positioning of the baby. Special X-rays are often required to tell the difference between deformational and craniosynostotic abnormal head shapes.

The craniosynostosis (abnormal head shape) can occur as the only deformity and this is called non-syndromic craniosynostosis. If the abnormal head shape occurs together with other deformities, it is called syndromic craniosynostosis. Different abnormal head shapes may result depending on which growth plate is affected.

Craniofacial clefts: Abnormal gaps in the skull and facial bones and/or soft tissue. This includes cleft lip and palate
Approximately one in 1 000 children are born with cleft lip and/or cleft palate. Cleft lip and palate can be corrected surgically, with the operations being performed at different ages. The cleft lip is usually corrected at about three months of age and the palate at about nine months. A specialised team is required to deal with these problems. The main members of the team include a plastic surgeon, an orthodontist, as well as a speech therapist.

Craniofacial clefts are much less common, but often more severe than the usual cleft lip and palate. These may involve the nose, maxilla (upper jaw) and eye socket. They can even extend into the cranium. These types of anomalies usually require several operations at different stages of facial growth. Conditions such as meningoencephaloceles involve herniation of the brain contents through a defect in the skull. This may occur as a result of a cranial cleft but may also occur as a separate entity on its own. These conditions also require surgical correction and may need more than one operation.

Growth abnormalities: Overgrowth/undergrowth of the bones or soft tissue
This could encompass overgrowth of certain areas of the head and face as well as undergrowth, resulting in disfigurement that can often be corrected by craniofacial surgery.

Fibrous dysplasia is a condition of overgrowth of the bone of the face and skull. It can occur in one area or many areas, including bones in the rest of the body. It involves the replacement of normal bone with “scarred” bone and continues to grow. It usually begins at about 10 years of age and continues until adulthood. This disease can limit itself but most cases need surgery, as major facial deformities can occur. It can also affect the bone surrounding important nerves, such as those to the eye, and can result in blindness without an operation.

Atrophic conditions: Bones and soft tissue develop well but then start to become smaller
Rhomberg’s disease is also known as progressive hemifacial atrophy. This condition is not exactly undergrowth, but it involves half of the face. Initially, the face develops normally and then one side starts to become smaller. This disease involves the skin, underlying fat, as well as the bone. It usually starts after age eight. The treatment involves surgery to fill the areas that are getting smaller.

Tumours: Including cancers and other growths of any part of the head and face
Tumours are growths that occur in certain areas and involve different cells of the body. These tumours may be benign (not life-threatening) or malignant (very dangerous) and spread to the rest of the body. Most of these tumours are disfiguring to the face and head and require corrective surgery. One type of benign tumour that often requires more than one surgery is called neurofibromatosis. It can be passed from parent to child. It is, however, very deforming in the involved area, which is often the face. It comes from abnormal nerve tissue that causes growths that may be massive and deforming. This disease can often involve many areas of the body. It requires surgery to remove most of the tumour and to reconstruct the deformed area. Unfortunately, it can grow again after surgery as it invades all the surrounding tissue as well.

Many other types of tumours can affect the craniofacial area. Some cases require other types of treatment like chemotherapy and radiotherapy in addition to surgery.

Trauma: Injuries that result in craniofacial disfigurement
Craniofacial trauma may result in defects that can be corrected. These may involve the soft tissue only but could also involve the underlying bony platform. The patient may require bone grafts and soft tissue grafts to reconstruct major defects. 

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