Understanding Craniofacial Prostheses in Pediatric Maxillofacial Medicine

For children undergoing maxillofacial surgery, the journey doesn’t end with the operation. Often, the path to recovery involves a unique tool: a craniofacial prosthesis. These custom-made devices not only repair appearance, but also play a crucial role in the child’s quality of life.

The world of pediatric craniofacial prostheses can be a scary place – it’s invasive, mysterious, unnatural. But it’s really the unknown that’s the scary thing; this sector of maxillofacial surgery for kids is holistic and restorative. So let’s unveil the not-to-mysterious details of craniofacial prostheses for children:

Types of Pediatric Orofacial Conditions

A craniofacial defect is a broad term for structural abnormalities in the mouth, face and head. These can be congenital (at birth) or acquired (develop from injury/illness). The features of each are different, and each occurs on a spectrum of severity, but all present significant threats to a child’s quality of life, development and psychological health.

These defects are uncommon in the general population, but the most-often treated pediatric craniofacial conditions include:

• Vascular malformations: Abnormal blood vessel growths causing disfigurement and potential functional issues.
• Syndromic conditions: Craniofacial features associated with broader genetic syndromes impacting other body systems.
• Hemifacial microsomia: Underdevelopment of facial structures on one side.
• Craniosynostosis: Premature fusion of skull bones, affecting brain growth and cranial shape.
• Cleft lip and palate: A separation in the lip and/or roof of the mouth, impacting speech, feeding, and facial appearance.

Types of Pediatric Craniofacial Prostheses

There are generally two types of surgically-installed prostheses for children:

• Complementary prostheses: These assist in the healing process or support other treatments. For instance:
  • Cranial prostheses: Protect the brain after skull surgery.
  • Obturators: Close openings in the palate to improve speech and eating.
  • Surgical stents: Maintain space for tissue growth after surgery.
  • Tracheostomal prostheses: Facilitate speech and breathing after a tracheostomy.
• Restorative prostheses: These replace missing or malformed facial features. For instance:
  • Auricular prostheses: Restore the ear after trauma or microtia (congenital small ear).
  • Cleft lip and palate prostheses: Aid speech, feeding, and facial development in children with cleft conditions.
  • Facial prostheses: Address larger areas of missing tissue due to tumors, burns, or other conditions.
  • Nasal prostheses: Restore the nose after trauma, tumor removal, or congenital defects.
  • Orbital prostheses: Replace missing or damaged eyes.

Benefits of Craniofacial Prostheses for Children

There are several benefits to a treatment plan for craniofacial defects that includes a prosthesis/es:

1. Quality of life: Prostheses can restore functions like speech, eating, breathing, and vision.
2. Psychological well-being: Improved appearance and function contribute to a child’s emotional and social development.
3. Preparation for surgery: Prosthetics can be used pre-operatively to plan and visualize surgical outcomes.
4. Post-surgical support: Complementary prostheses aid healing, prevent complications, and improve surgical results.
5. Aesthetics: Prostheses improve a child’s appearance, boosting self-confidence and reducing social stigmas associated with orofacial defects.

Special Considerations in Pediatric Maxillofacial Surgery

In addition to the complex nature of congenital and acquired craniofacial defects in children is the complex nature of treating structural damage/deformities on a growing skeleton. Care must be completed in steps as the child develops; prostheses need to be adjustable; long-term relationships with oral and maxillofacial health providers are vital.

As well, all adults involved must be aware of the psychological impact a craniofacial prosthesis can have on a child, and ensure self-love and acceptance. Perhaps most important of all (in children who are old enough) help the child understand the purpose, timeline and intention of the treatment.

Pediatric maxillofacial medicine saw dramatic developments in the 20^th century, and that progress continues today. Children require patient, gentle care by an orofacial doctor who monitors their growth. With the right oral and maxillofacial surgeon who has the skill, specialization and qualified medical team, your child can have the quality of life they were meant to.