Plastic surgeon Dr Chia Hui Ling on common deformities among children in Singapore
“Parents, who are caring for children with deformities, need to know that, they can seek medical attention for their child’s condition. It is also equally important to discuss treatment options with a healthcare practitioner early,” explained Dr Chia Hui Ling, Associate Consultant at the Department of Plastic, Reconstructive and Aesthetic Surgery in KK Women’s and Children’s Hospital (KKH).
In Singapore, there are less than 10 plastic surgeons who focus on paediatric plastic surgery, added Chia. Some common conditions in children that the Department of Plastic, Reconstructive and Aesthetic Surgery at KKH provides treatment for include burn injuries, cleft lip and palate, craniofacial deformities (craniosynostosis, facial cleft and ear deformities), “birthmarks” such as vascular anomalies (eg, haemangioma and vascular malformations) and naevi, paediatric trauma and reconstruction, paediatric tumour reconstruction and paediatric hand surgery.
Common congenital deformities
Some of the more common deformities, which do not have gender predilection, are:
Some children have ears that stick out or otherwise look different from normal. These differences are commonly noticed at birth but a lot are also picked up as the child grows. Ear deformities in children can be corrected very effectively by moulding, a nonsurgical treatment, from birth until 1 month of age. Ear moulding after 1 month of age is still possible but the effectiveness decreases with age. Ear deformity may be one of the most common birth deformities but many are not aware that by moulding – wearing a simple splint for a few weeks – the deformation can be corrected without surgery and the effectiveness is more than 90 percent. If the opportune period of moulding is missed, ie, three months of age, the ear deformity can be surgically corrected after five years of age.
Cleft lip and palate
A cleft refers to a split or gap in the upper lip, roof of the mouth (the palate) or sometimes both. Cleft lips and palates develop during pregnancy and ... is thought ... a combination of genetic and environmental factors contribute to their development. They are the most common facial birth abnormalities in Singapore.
For cleft lip and palate deformities, treatment is provided from birth in the form of feeding interventions and nasoalveolar moulding, to adulthood, where surgeries such as orthognathic surgery and rhinoplasty are performed. The very first surgery that a baby with cleft lip has to undergo is typically performed at three months of age.
Birthmarks are very common in infants – and most of them are pretty harmless. They are usually areas of discoloured and/or raised skin that are apparent when your baby is born or within a few weeks of birth. Birthmarks are composed of pigment cells or blood vessels and most are benign and do not require any treatment.
Age of surgery varies for children with birthmarks because these are usually only operated upon if they cause functional problems such as the birthmark obstructing the child’s vision. Deformities can often lead to psychological distress or have potential to become malignant. However, some birthmarks such as haemangioma will often involute and do not require intervention.
Burn injuries make up the most common acquired condition attended to by the plastic surgeons at KKH. Burn injuries are more common among toddlers and the most common cause of such injuries is scald burns.
Handling complex cases
Conditions that affect multiple body systems are known as syndromes, such as Apert Syndrome, where the cranial and facial skeleton, limbs and heart may be affected. KKH has the largest paediatric plastic surgery practice in Singapore, hence the hospital sees many patients with these complex conditions from Singapore as well as the neighbouring countries.
At KKH, a child identified with a syndrome is treated and followed up from birth until adulthood. The child will receive treatment from a multidisciplinary team consisting of experts from various specialties, with the aim of providing optimal care for each of the child’s medical problems. In addition to plastic surgeons, other specialists may include neurosurgeons, otolaryngology surgeons, ophthalmologists, dentists, geneticists, paediatricians, specialist nurses, speech therapists, dietitians and psychologists.
The schedule of each child’s treatment is customised and prioritised according to the functional needs of the child. For instance, surgery targeted to restore essential functions, such as airway, vision and feeding, are carried out as early as possible. Surgery to establish normal speech, appearance and dental occlusion are performed at a later age.
“Healthcare professionals can play an important role in helping families cope with the challenges involved for children who have deformities. They need to take every opportunity to leave the lines of communication open with parents and help them along their journey from the initial diagnosis to essential educational information, and finally to the future needs of that child,” concluded Chia. MIMS
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