MU Doctor Gives Children a Reason to Smile
Craniofacial clinic corrects clefts
According to the Centers for Disease Control and Prevention, cleft lip and cleft palate are now the most common birth defects in the United States. Arshad Muzaffar, MD, director of the craniofacial/cleft lip and palate pediatric plastic surgery program at MU, provides comprehensive treatment for these birth defects as well as other complicated craniofacial anomalies.
“Our program at the craniofacial clinic includes not only the craniofacial surgeon but also other subspecialists such as a pediatrician, a geneticist, a neurosurgeon, an orthodontist, a speech pathologist, an otolaryngologist, an audiologist, a social worker and an ophthalmologist, among others,” Muzaffar said. “This teamwork allows all of us to work together on specific treatment plans for each child.”
The majority of clefts appear to be the result of a combination of genetics and environmental influences, and the risks of recurrence in a family depend on many factors.
“A child born with a cleft is usually faced with multiple and complex issues from the start, such as early feeding and nutritional problems that can lead to difficulties in growth and development,” said Muzaffar, an associate professor of plastic and reconstructive surgery and child health. “Orofacial clefts may also cause middle-ear infections, hearing loss, deviations in speech and resonance, dento-facial and orthodontic abnormalities, and possible psychosocial adjustment issues as the child grows older.”
Patients at the craniofacial clinic can also receive specialized care before surgery. A technique known as nasealveolar molding can improve the results of surgery to repair a cleft lip or cleft palate. MU Children’s Hospital is one of the few hospitals in the United States to provide this pre-surgery technique for patients.
“We use a custom-made retainer-like appliance designed by our orthodontist to align the segments of the lip and gum as well as shape the nose,” Muzaffar said. “After several weeks, the two cleft segments and the nose are in a more normal relation. Then surgery is performed to fully repair the defect.”
Muzaffar also repairs less common defects such as Pierre Robin Sequence (PRS), a birth condition that involves the lower jaw being either small in size or set back from the upper jaw. As a result, the tongue tends to be displaced back toward the throat, where it can fall back and obstruct the airway. Most PRS patients, but not all, will also have a cleft palate, but none will have a cleft lip. The cause may be an abnormal position of the baby while in the womb or genetic reasons. In most babies, the breathing problem can be managed with positioning, but in severe cases, surgery may be required to prevent failure to thrive or even death.
“Traditionally, a tracheostomy would be performed,” Muzaffar said. “However, we offer the most recent surgical advancement — mandibular distraction — right here at our clinic.”
Mandibular distraction is a technique that lengthens the jaw through bone growth. The jaw is gradually moved forward over several days, using a device that is surgically attached to the jaw. As the jaw moves forward, the tongue also moves forward, and the airway obstruction is then relieved.
For all types of treatment provided at the craniofacial clinic, Muzaffar believes in treating each child as an individual. Often parents of children with congenital anomalies feel anxiety, but Muzaffar works to alleviate this anxiety by clearly explaining to the child’s parents what to expect in the coming months and years.
“The best treatment outcomes stem from the combination of surgical excellence and a compassionate and individualized approach to each of my patients,” Muzaffar said.
Before joining MU in November 2005, Muzaffar served as an assistant professor of plastic surgery at the University of Washington School of Medicine and a pediatric plastic surgeon at Children’s Hospital and Regional Medical Center in Seattle. He received a medical degree at Yale University School of Medicine in New Haven, Conn., and completed training in craniofacial surgery at Harborview Medical Center and Children’s Hospital and Regional Medical Center in Seattle, training in hand surgery and microsurgery at University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children in Dallas, and training in general and plastic surgery at the University of Texas Southwestern Medical Center in Dallas.
This story was republished from Medical School Update of the University of Missouri-Columbia School of Medicine.
Photo by Jeff Hoelscher