Plastic surgery in children includes injuries as a result of falls, congenital or subsequent disabilities, deformity, traffic accidents, animal bites, household accidents, burns. Compared to adult patients, pediatric patients require different information and practices.
For example, cleft lip has a different surgery timing and cleft palate has a different surgery timing. In this timing, the development of the patient, the state of the cleft are very important factors.
In the formation of cleft lip or cleft palate, the cause cannot be found definitively. However, medications taken during pregnancy, X-rays, stress, traumas or some viral diseases, deficiency or excess of some vitamins have been blamed. There is also the possibility of passing the disease by heredity. Most of these children do not have another congenital defect or anomaly. Most patients are normal in terms of intelligence and ability. In children with clefts, the risk of fluid collection in the middle ear – serous otitis media – is high. If left untreated, it can lead to ear infections and ultimately hearing loss. Most children with cleft may have dental abnormalities (such as crooked teeth, missing or excess teeth).
Children with cleft lip and palate may benefit from specialized teamwork. The cleft team consists of plastic surgeon, otolarigologist, pediatrician, maxillofacial surgeon, geneticist, dentist, speech therapist, audiologist and psychologist. When the baby is 6-10 weeks old, the cleft lip is operated. This period is expected for the baby to reach a certain weight (4.5 kg.) that cannot be damaged by anesthesia. Cleft palate surgery is performed according to the degree of cleft in a 6-18 month period. Scar tissue caused by surgery on the prematurely operated palate may adversely affect the development of the upper jaw and face. If operated on later, this time the child learns to speak with the cleft palate and it becomes difficult to correct the speech after the palate is repaired.
The exact age for surgical repair depends on the child’s health, size, and surgeon’s preference. Some children with a cleft palate may require a second palate surgery to get better results. In children with a cleft in the toothline, it may be useful to put a piece of bone (graft) in the cleft line during surgery. This is called an alveolar bone graft. This part allows the permanent teeth to come better. This surgery is performed between the ages of 6-10 by looking at the growth rate of the permanent teeth.
In children with cleft lip, additional surgery may be required at a later age to correct the scars (scars) remaining on the lip after surgery. Nose surgery may then be needed to correct breathing or appearance. Especially in children with bilateral cleft lip, if the part between both nostrils called columella is short, extension surgery is performed around the age of 6 before starting school. In the case of cleft lip, after completing the development of the nose around the age of 18 after the adolescent period, surgery is performed to correct the cartilage and soft tissue deformities at the tip of the nose (this is called cleft-lip nose). It is preferable to perform this surgery with open rhinoplasty, where the cartilage structures can be shaped better. Hemangiomas and lymphangiomas, which are the most common benign skin tumors seen in newborns, may be present at birth or may appear later in the first months of life. Hemangiomas?’ It can regress to puberty and disappear completely. However, instead of regression, hemangiomas that continue to grow, bleed frequently, or in important areas (such as eyelids, mouth edges) may need to be surgically removed without waiting.
Large vascular lesions can be life-threatening or also create disappearance disturbances.
Laser therapy is the most preferred treatment in the treatment of vascular lesions, including port-wine stain and non-regressive strawberry hemangioma. Careful evaluation is required before laser treatment. Among the most common hand malformations: syndactyly (adhesion between two fingers), polydactyly (excess finger), trigger finger, curled finger, finger deficiency, finger shortness and absence of fingers. Syndactyly can also be on the toes. In all congenital malformations, it should be investigated whether there is another concomitant organ or tissue anomaly.
Plastic surgery can successfully correct many hand malformations; in other cases, it can provide some degree of functional capacity. For functional restoration, toe transfers from the foot to the hand can be given as an example for hypoplastic or aplastic finger anomaly. It should be emphasized that the function should be kept in the forefront before cosmetics by talking to the mother and father. Timing is important in syndactyly surgeries. It is 24 months, which is when the control of the fingers begins, and it is preferred that the surgery is performed up to 36 months (3 years). In addition, surgery can be performed on older children. But especially early treatment of complex syndactyly is recommended. Especially the fingers with a height difference are treated earlier, considering that they may distort the shape of each other during growth. Surgery in newborns is not preferred especially because of the drawbacks of anesthesia.
Most infant and child burns occur as a result of scalding with hot liquids, and the cause of scalding burns is parental neglect and abuse. Burns on the hip occur especially as a result of sitting the child in boiling water as a punishment. The priority in scalding burns is to determine the prevalence of injury. The calculation of burn area and rate in infants and children is different from that of adults, as there are differences in the ratio of the head to the body. Ear and hand burns require special attention. Even superficial ear burns can result in scatrization and deformation. Hand burns have the potential to lead to contracture and scatrization that restrict function. A plastic surgeon should be consulted for burns of sensitive areas such as the ear and hands.
Facial injuries in children have the potential to leave permanent sequelae and require special treatment methods. Failure to suture even very small lacerations on the face may result in poor healing and skatrization. Treatment of facial soft tissue injuries is best done in the operating room and by a plastic surgeon instead of in the emergency room. In children, wound healing is much faster and the scarring rate may be less. However, if the child has hit his head, it is useful to be examined by the pediatrician and, if necessary, by the neurosurgeon for head trauma.
Animal bites in children can create special problems; for example: the face is injured in the majority of dog bites in children and is typically in the form of lacerations (tearing or rupture).
Proper cleaning and meticulous repair should be performed by a plastic surgeon.
Correcting conditions such as lack of development in the ear before school age can prevent mental problems that may occur as a result of the child starting school and attracting the attention of friends.
