Summer 2013

Comprehensive Treatment for Complex Craniofacial Anomalies

Dr. Karin Vargervik

Dr. Karin Vargervik

When an infant presents with a craniofacial syndrome that includes craniosynostosis – a deformity that involves premature skull suture closure – initial and ongoing treatment demands a comprehensive, interdisciplinary approach, says orthodontist Karin Vargervik, DDS, director of the Center for Craniofacial Anomalies at UCSF Benioff Children’s Hospital.

Such an approach includes early surgery – usually before the child turns 1 – but also a range of other services across an entire childhood.

"Certainly, a center needs an armamentarium of surgical techniques and expertise," says Vargervik. "But the specific timing and nature of each surgery requires input from many disciplines that consider the complex and ongoing needs of each individual child."

Surgical Experience and Collaboration

Dr. William Hoffman

Dr. William Hoffman

Though many specialized centers provide corrective surgery and team management for craniofacial birth defects, experience matters for the best outcome. William Hoffman, MD, chief of the Division of Plastic and Reconstructive Surgery at UCSF Medical Center, has done more than 500 such procedures. And his associate, Jason Pomerantz, MD, of UCSF Benioff Children’s Hospital, completed a specialized craniofacial surgery fellowship.

For all surgical procedures involving the brain, the two work with pediatric neurosurgeons to reshape patients’ skulls and create space for normal brain growth, either with distraction osteogenesis or with more open surgery, often using absorbable plates and screws for stabilizing purposes.

Comprehensive Follow-Up

Dr. Jason Pomerantz

Dr. Jason Pomerantz

Yet the surgical procedures are only part of the care provided by a craniofacial team that addresses the many challenges these patients face, which can include swallowing and breathing difficulties and, later, problems with hearing, speech and chewing. “It’s a combination of improving appearance and functionality,” Hoffman says.

That’s why children born with craniofacial anomalies need interdisciplinary treatment planning and follow-up care, says Vargervik.

Many will require specialized educational programs, hearing aids, speech therapy, specialized dental care and orthodontics over time, as well as psychosocial support to help them and their families tackle the many challenges that often accompany these genetic and congenital conditions.

"Plastic surgeons, oral surgeons, orthodontists, social workers, nurse practitioners, speech pathologists, audiologists, pulmonologists and other specialists all play a role," says Vargervik. "And because some of these conditions stem from genetic mutations, a geneticist who can arrive at a firm diagnosis and a genetic counselor are very important components of our team."

"Having all team members together in one visit also can make it easier and more efficient for patients," says Hoffman.

"We follow our patients’ entire development very carefully," says Vargervik, who will transition to an emerita position this summer after having groomed a new generation of clinicians to advance this approach. In addition to Pomerantz, the new generation includes Snehlata Oberoi, DDS, a specialist in craniofacial orthodontics, and pediatrician and geneticist Ophir Klein, MD, who will become the center’s acting director.

Vargervik notes that the center has several thousand patients on record and sees 700-800 patients yearly for team evaluations.

"For each patient, we come up with a coordinated plan that spans from birth until patients turn 21," says Pomerantz. "It’s a long-term relationship and commitment."

For more information, contact the Center for Craniofacial Anomalies at (415) 476-2271.

     

Summer 2013 Table of Contents

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