Recommended Treatments

Treatments for Newborns
Treatments for between 2 and 4
Treatments for between 6 and 8
Treatments for between 8 and 10
Treatments for the teenage years
Treatments for after the teenage years

WHAT TREATMENT IS RECOMMENDED
IN THE NEWBORN?

Attention is directed towards assessing the vital functions such as breathing, eating and sleeping. In rare cases the lower jaw is so severely deficient that the tongue obstructs breathing during sleep and a temporary tracheostomy is recommended. Once the airway is secure, attention is directed to feeding to make sure the newborn is taking adequate calories and is growing appropriately. In the event the child is unable to feed adequately, a temporary feeding tube or gastrostomy (stomach tube) may be recommended.

WHAT TREATMENT MAY BE RECOMMENDED
BETWEEN AGES TWO AND FOUR?

In patients who are mildly affected, no treatment will be necessary in this period. In patients with severe underdevelopment of the lower jaw, however, the mandible (lower jaw) is either reconstructed using a bone graft taken from the ribs or the underdeveloped mandible is lengthened using a bone distraction device. The bone lengthening technique has certain advantages. It requires only a short operation to insert and the parents are able to lengthen the mandible at home by tuming a simple screw at the end of the device. The lengthening process is painless and the technique avoids the need for bone grafts which are painful and leave scars on other parts of the body. After the bone grafting or bone lengthening procedure has lengthened the lower jaw on the affected side, there will be a gap between the upper and lower teeth on that side. The orthodontist inserts a plastic retainer which is gradually modified to allow the upper teeth to grow down into the gap until they contact the lower teeth. This process tends to level the mouth and the teeth.

WHAT TREATMENT IS RECOMMENDED
BETWEEN THE AGES OF SIX AND EIGHT YEARS OF AGE?

This is the period when the external ear may he reconstructed. This is particularly applicable to patients who are not severely affected. In patients with severe facial asymmetry, the ear reconstruction is of a relatively lesser importance when compared to
the reconstruction of the jaw and cheek contour, and in such patients the ear reconstruction may be delayed or reconstructed with a prosthesis (artificial ear). The ear reconstruction is performed as described in the Microtia Page. This technique involves
several stages over the course of six to twelve months.

WHAT TREATMENT IS RECOMMENDED
BETWEEN THE AGES OF EIGHT AND TEN YEARS OF AGE?

This is the period when the asymmetry in cheek fullness is reconstructed. In terms of the overall appearance of the patient this may he the most important stage in the entire treatment program. The cheek fullness is reconstructed using soft tissue taken from another part of the body, such as the back or the lower abdomen. The tissue is transferred along with its blood supply using a technique called microsurgery. This is the period during which additional orthodontic therapy may be performed.

WHAT TREATMENT MAY BE RECOMMENDED
DURING THE TEENAGE YEARS?

In those patients who had relatively mild involvement and did not need surgical treatment of the lower jaw in early childhood, the teenage years is the period when jaw surgery may be performed. In addition, the severely involved patient who did undergo lengthening or bone grafting in early childhood may require further treatment in the teenage years because of the growth of the lower jaw which occurs in adolescence. The advantage of jaw surgery in the mid to late teenage years, is that the patients are fully grown or nearly so. As a result, the treatment plan does not need to make provisions for facial growth. jaw surgery at this age can include bone lengthening, but usually involves treatment of both the upper and lower jaws. It begins with orthodontic manipulation of the teeth to prepare the patient for surgical movement of the jaws.
The surgical procedure involves temporarily wiring the jaws together during the operation. In some cases the wires are removed at the end of the operation. After the procedure orthodontic manipulation of the teeth may be necessary to insure that the bite is exactly correct. Because of the presurgical and postsurgical orthodontic treatment, the jaw surgery process may take over one year to complete.

WHAT TREATMENT MAY BE RECOMMENDED
AFTER THE TEENAGE YEARS?

The goal of the craniofacial team is to have even the most severely affected patients completely reconstructed by the age of 18. It is not uncommon, however, for patients to require minor touch-up procedures beyond that age.