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When a child is born with a disfiguring condition like a cleft lip or palate, or receives an injury that leaves permanent damage, it is important to consult with doctors to determine how best to treat the condition or injury. In some cases, the pediatrician will recommend reconstructive surgery to restore whatever body part is affected to mobility, functionality and appearance.
Depending on the condition, the child may be able to have surgery within his or her first year of life. In some cases, it may be better to wait longer. And in other cases, a series of surgeries may be needed.
At the Johns Hopkins Department of Plastic and Reconstructive Surgery, our staff includes surgeons who specialize in pediatric surgery, treating a wide range of conditions and injuries. They can work with the pediatrician and parents to determine what type of surgery is best suited to the condition or injury and to the child’s situation and environment.
At the Department of Plastic and Reconstructive Surgery, cleft lips and cleft palates are repaired by Dr. Richard Redett, the only fellowship-trained pediatric plastic surgeon in Maryland. Learn more about cleft lip and palate surgery.
Craniofacial microsomia, sometimes known as hemifacial microsomia or otomandibular dysostosis, among other names, is a condition that causes children to be born with underdeveloped or small parts of the face, most commonly the jaw and ear (which may be called microtia). After cleft lips and palates, this is the most common facial birth defect.
Some children are born with Pierre Robin Sequence, which may also be called Pierre Robin Syndrome or Pierre Robin Malformation. It is characterized by a jaw that is too small, a cleft palate, retraction of the tongue and upper airway obstruction. As with other types of facial conditions, the jaw and cleft palate can be repaired with surgery.
Other conditions and syndromes that we treat include:
For the treatment of these conditions, a pediatrician may recommend surgery. When the surgery is done depends on the exact condition and the needs and situation of the child.
Jaw surgeries: For a child born with a small jaw or receding chin, a reconstructive surgeon can correct the condition through several different kinds of surgery. Most commonly, the reconstructive surgeon will cut the jawbone, a procedure known as an osteotomy, to reposition it using titanium screws and plates, which eliminates the need for wiring the teeth together.
Another technique, distraction osteogenesis, splits the jawbone and then moves the jawbone slowly by inserting a screw either inside the mouth or outside and turning it periodically over a few weeks. The advantage of the distraction technique is that it simultaneously increases bone length and the volume of the soft tissue around the bones.
The plastic surgeon may also create a new jawbone structure using bone grafts from the ribs, hips, or skull, or alloplastic grafts, which are created from synthetic materials.
Ear surgeries: Reconstructing the ear to make it a normal size will likely require three surgeries over a period of time. In some cases, a child may need an artificial or prosthetic ear, which also requires several surgeries.
Repairing the ear can take anywhere from two to four surgeries. The reconstructive surgeon may recommend using the child’s ribs to reconstruct the ear or may decide that an alloplast—synthetic material—would be best.
In infants, brachial plexus injury most often occurs during an abnormal or difficult birth, causing damage to the brachial plexus nerves (shoulder dystosia). Depending on the injury, a baby may be diagnosed with different kinds of palsy, including Erb’s palsy and Klumpke’s palsy. In about one in 10 cases, the child will need some kind of surgery to repair the nerves. Generally, surgeons recommend that the surgery be done when children are between the ages of four and nine months.
Several of our reconstructive surgeons specialize in working with children. When an infant is born with genital defects that require surgery, our surgeons will work with parents and the referring physician to determine if surgery is needed. They also consult and work with other specialists such urologists and gynecologists. A number of innovative techniques are available to reconstruct genital defects, including tissue transfer.
At Johns Hopkins, our reconstructive pediatric surgeons have done hundreds of surgeries on children of all ages to restore appearance and functionality. They have learned about and, in many cases, taught the latest and most effective surgical techniques. In addition, because they work at Johns Hopkins, they can call on any other kind of medical expertise needed right at the facility, from pediatricians and orthopedists to ear, nose, and throat specialists (otolaryngologists) and dermatologists.
Our surgeons are devoted to their profession and to providing attentive patient care. From the first consultation to the final check-up, our reconstructive surgeons make themselves available and accessible to patients and their families.
We offer services at 4 convenient locations in and around Baltimore, Maryland:
Meet the Surgeons
Our experts specialize in a wide variety of cosmetic and reconstructive procedures.