CRANIOFACIAL AND CLEFT CENTER

Craniofacial problems are not rare. One in every 500 children is born with craniofacial problems such as cleft lip and palate. There has been significant progress in the care of these children over the last decade. With early treatment and intervention, the majority of children who are born with these problems can live happily with more normal facial features.

Our team is dedicated to the early diagnosis and treatment of craniofacial anomalies. The Craniofacial and Cleft surgery provides complete care for your child including a team of pediatric specialists. The Center brings together geneticists, audiologists, speech pathologists, reconstructive plastic surgeons, neurosurgeons, ophthalmologists,pediatric dentists, orthodontists, oral surgeons, prosthodontists, and

Center team members strive to provide the most efficient and convenient care possible by avoiding long hospital stays and performing outpatient procedures whenever possible. Eighty percent of outpatients go home the day of surgery. Above all, we are experts in providing child-friendly care which attends to the emotional as well as the physical needs of children and their families.

Craniosynostosis

It is estimated that 1 of 3,100 to 3,500 infants are diagnosed with craniosynostosis or premature fusion of the cranial sutures (spaces between the skull bone plates). Although many more infants have mis-shapened heads from: 1) deliver at birth and positioning on the back (deformational plagiocephaly), tight neck muscles (torticollis), ocular movement problems or cervical spine abnormalities, these groups of patients do not require surgery. Patients with craniosynostosis require surgical release of the fused sutures (excision) and cranial vault remodeling.

At SIPS the craniofacial team of craniofacial surgeons, neurosurgeons, pediatricians, geneticists and others evaluate all patients and recommend treatment. Procedures are tailored to the individual needs of the patient. The team is very experienced in treating patients with:

scaphocephaly or sagittal suture fusion, plagiocephaly or unilateral coronal suture fusion, brachycephaly or bilateral coronal synostosis trigonocephaly or metopic suture fusion and the more rare) lamboidal synostosis or posterior plagiocepahly.

The team works closely with the SIPS pediatric anethesiologists and critical care team who provide a safe recovery.

Cleft Lip and Palate

The SIPS Clinic is one of the best center in the India and provides consultative and surgical treatment for patients on a weekly basis.

Our team is composed of internationally recognized experts who provide state-of-the-art treatment for all children with birth defects.

The SIPS Medical Center is rated as one of the top two hospitals in the India and the best hospital in the North India.

EAR RECONSTRUCTION SURGERY

Ear reconstruction is considered as one of the most challenging operations in plastic surgery. Ear reconstruction is requested by two main groups of patients: those who have an underdeveloped ear at birth (a condition known as microtia) and those who have lost a normal ear through trauma, disease or previous surgery.

Microtia example	Microtia example	Trauma example

The reconstruction process is in two stages, about 6-12 months apart. The first stage involves creating a skin pocket at the site of the ear by re-orientating the available tissue and thinning the skin to mimic the ear skin. Rib cartilage is then harvested in three pieces. These are carved and wired together with fine stainless steel wire to produce a very detailed ear framework. The framework is then inserted in the pocket and gentle suction is applied to enable the skin to adhere to framework. This operation takes 4-6 hours and the expected length of stay in hospital is 5-7 days.

The second stage involves releasing the ear from the head and inserting a piece of cartilage behind it to maintain projection. A flap of vascularised tissue is then utilised to cover the exposed cartilage. This is either transposed from behind the ear or rotated from under the scalp. This is then covered by a skin graft (taken from the scalp, thigh or groin). The second stage takes 3-4 hours and the expected hospital stay is 2-3 days.

For congenital ear abnormalities (microtia), surgery is usually deferred until the age of nine or above. This because prior to this age there is generally insufficient volume of rib cartilage that needs to be harvested for the reconstruction. This operation can be performed at any age in adulthood although it can be more difficult in the older age group because of cartilage calcification. The psychological benefit of ear reconstruction to the patient is immense. Prior to reconstruction most of the children are withdrawn, lack confidence and suffer from teasing at school. Adults are also affected in a similar manner following ear loss.

The operation has a high success rate with over 90% of the reconstructed ears being graded good / excellent by our patients. However, in patients who have significant scarring or a low hairline, more complex techniques may need to be used (see the gallery for examples). It is therefore recommended that all patients requiring ear reconstruction be referred to a specialist in the field.

The alternative to autologous ear reconstruction is a prosthetic ear (Branemark). This is clipped on to two titanium pins inserted into the skull. There are pros and cons to each method. The disadvantages of prosthetic ear are that it needs to be removed daily for cleaning, it can be accidentally unclipped from minor trauma, frequently complicated by problems around the pins throughout life and suffers from poor colour match. The advantage is that it is a simpler operation compared with autologous reconstruction.

Before After Before After After Before After

Congenital Anotia

Exostosis Right Forehead

Loss of eye

Tessier Cleft type-3

Tessier Cleft type-4

Tessier Cleft type-7 (Macrostomia)