Among the nearly 300 centers in North American providing some type of craniofacial care, the Medical City Children's Hospital Craniofacial Center is one of only a half-dozen that treat a high volume of complex cases. While most of the other large craniofacial centers are university-affiliated, with only one surgical team providing services, our center draws on the talents of several large private surgical practices and a hospital-based multidisciplinary craniofacial team.

Medical professionals trained in more than 15 disciplines work as a team to correct a child’s physical problems. Team members contribute their knowledge and experience to diagnosis of the patient, then plan for appropriate treatment procedures and continuing follow-up care. They help patients adapt to each stage of their life and learn how to use or reuse the abilities which their deformities once made impossible. The team helps the child and family deal realistically with treatment, addressing a range of physical, psychological and social needs. The team also conducts ongoing research to enhance treatment techniques, following patients and their progress into adulthood.

Here is a brief description of what each team member does:

Craniofacial Surgeon
The craniofacial surgeon is a plastic and reconstructive surgeon specifically trained to treat craniofacial conditions and whose practice is limited to this type of surgery. As the team leader, this doctor coordinates the efforts of all other specialists. Through years of experience in treating craniofacial deformities, the craniofacial surgeon is able to recognize the more subtle distortions of the craniofacial region.

Pediatric Neurosurgeon
The pediatric neurosurgeon works with the craniofacial surgeon in patient evaluation and surgical procedures. The unique partnership between the neurosurgeon and craniofacial surgeon has led to the development of many new techniques at the center that allow for successful treatment of many anomalies once thought uncorrectable.

Pediatric Neuroradiologist
The pediatric neuroradiologist is a physician who aids the surgeons in patient diagnosis and treatment. The radiologist uses a wide array of techniques, including computerized axial tomography (CAT scan), three-dimensional (3-D) reconstruction of CAT scans and magnetic resonance imaging (MRI) to document a child’s condition. These examinations provide much of the information needed to define a patient’s craniofacial problem. Images of the skull and facial bone structure, as well as the soft tissues of the brain, orbits and face, are studied in planning corrective surgery.

Pediatric Anesthesiologist
The anesthesiologist is a specialist in pediatric anesthesia and neuroanesthesia who monitors and supports the patient’s vital signs during surgery. He or she also uses special techniques such as hypotensive anesthesia to decrease blood loss.

Otolaryngologist
The otolaryngologist examines the patient and provides treatment for any problems relating to the ear, nose or throat. Particular attention is given to any structural abnormalities in the airway that might interfere with or influence the delivery of anesthetic during surgery.

Speech Pathologist
The speech pathologist provides assessment, diagnosis and treatment of speech and language problems, including detailed assessment of speech and palate function prior to surgery. When required, the pathologist makes audio and video recordings for analysis of speech sounds and lip and tongue movements, as well as to keep a record of the patient’s speech progress throughout treatment.

Geneticist/Pediatric Medicine
The geneticist determines whether a patient’s problems fit a known syndrome, providing the foundation for genetic counseling. Because some craniofacial syndromes are known to be hereditary, the geneticist may be able to advise you as to the risks for siblings and unborn children. The information obtained by the geneticist also helps expand the current body of knowledge about craniofacial disorders. As more disorders are discovered and described in medical literature, new methods of treatment, and possibly prevention, can be developed.

Social Worker
Craniofacial deformities can have devastating effects. The social worker evaluates the effects of the facial deformity on patients and their families. Early in treatment, the social worker talks with the patient and family to set realistic expectations for surgery. He answers questions concerning the surgery or hospital stay and provides insights that are helpful in preparing for surgery. He also provides family and individual counseling and referrals. The social worker meets with parents to obtain a complete family history, assess coping abilities and expectations, and provide referrals to community resources, including family and patient support groups. The social worker is a valuable family resource, both when patients are in the hospital and after they return home. He is ready and able to assist in dealing with problems the family may encounter.

Anthropologist
The anthropologist, who is specially trained and highly experienced in craniofacial conditions, takes some 150 measurements of the head and face of the patient. This data is compared to that of unaffected children of the same age and sex. The comparisons show the area and degree of defect, information that is used in planning surgery. The measurement process is usually repeated at intervals after surgery to allow the anthropologist to follow the growth pattern. These measurements provide valuable information for use in treating future patients.

Photographer
The photographer, like all members of the team, is skilled in working with craniofacial patients. Photographs are an important part of each patient’s evaluation and treatment. They are used in treatment planning and research and as part of the patient’s permanent medical record.

Craniofacial Nurse Coordinator
The craniofacial nurse coordinator coordinates new patient evaluations in accordance with patient diagnostic protocols. The nurse coordinator provides education in preparation for the surgical experience and serves as a patient and family resource and liaison throughout evaluation and treatment.

Team Secretary
The team secretary assists the nurse coordinator in providing patients and families with schedules and other information they request. The team secretary is also available to assist patients and families in making transportation and lodging arrangements.

Pedodontist and Orthodontist
The pedodontist and orthodontist play significant roles in the care of craniofacial patients, providing preventive, educational and therapeutic services related to oral hygiene. The orthodontist may apply braces and plan surgical corrections to determine the amount of dental-skeletal movement necessary to achieve desired results. Regular visits with the dentist and orthodontist are a critical part of the craniofacial patients’ care plan and help ensure optimal healing after surgery.