The Craniofacial Anomalies (CFA) Center at Lucile Packard Children's Hospital at Stanford provides comprehensive evaluation and treatment for children with abnormalities of the face and head. Directed by Dr. Stephen Schendel, chief of plastic and reconstructive surgery, the center is staffed by medical providers on the faculty of the Stanford University School of Medicine.
Newborns, toddlers, school-age children and adolescents with theses types of congenital abnormalities or acquired conditions can benefit from a multidisciplinary CFA team evaluation. During the initial evalutation, the CFA staff will get to know your child as an individual in order to recommend a treatment plan best suited to his or her needs. The staff's goal is to provide you with all the information you need so that you can make informed decisions about your child's care.
California Children's Services (CCS) has designated our program as a referral center for children covered by CCS.
Multidisciplinary Approach to Care
Children with craniofacial anomalies may have problems with their appearance, as well as many other system problems. At the CFA Center, your child may be evaluated by an audiologist, neurosurgeon, orthodontist, dentist, pediatric geneticist, plastic surgeon or speech pathologist. Social workers and genetic counselors also may work with patients to help them cope with the emotional stress of a disfigurement. All of these professionals are part of a team, so each child receives comprehensive, multidisciplinary care.
Innovative Treatment
The CFA Center offers the most advanced techniques in the
evaluation and management of children with the full spectrum of
craniofacial anomalies., including:
-Cleft lip and/or palate
-Abnormal skull shape and its effect on growth
-Poorly developed or absent jaws, ears or other facial
parts
-Speech difficulties related to anatomical or functional
problems
-Poor dental occlusion due to abnormal bone position or
development
-Acquired facial deformities resulting from injury or
disease
-Multiple congenital abnormalities
Some of the factors may include:
What are Craniofacial Anomalies?
Craniofacial Anomalies are a diverse group of deformities in the
growth of the head and facial bones. These abnormalities are congenital
and there are numerous variations. The most common type of anomaly is
cleft lip and/or palate.
What causes Craniofacial Anomalies?
There are many factors that may contribute to the incidence of
craniofacial defects. Most medical professionals agree that there is no
single factor that is the cause of these types of abnormalities.
a) Combination of Genes- A child may receive an abnormal gene from
one or both parents, or there may be a change in the genes at the time of
conception.
b) Environmental- There is no data that shows direct correlation
between any specific drug or chemical, however any prenatal exposure
should be evaluated.
c) Folic Acid Deficiency- Studies have shown that women who do not
take sufficient Folic Acid prenatally have a higher risk of having a baby
with congenital anomalies, including cleft lip/palate.
What are the most common types of Craniofacial Anomalies?
1) Cleft lip and/or palate: Separation that occurs in the lip or the
palate (roof of the mouth), or both. This is the most common congenital
craniofacial defect.
2) Craniosynostosis: Early closure of one or more sutures (soft
spots) in the skull of an infant, causing a head deformity.
3) Hemifacial Microsomia: Condition in which the tissues on one side
of the face are underdeveloped. It occasionally affects both sides of
the face and may involve the skull. Also know as "Brachial Arch
Syndrome" and "Lateral Facial Dysplasia".
4) Vascular Malformations: Birthmark or congenital growth, which is
composed of blood vessels that can cause functional or aesthetic
problems. They may involve multiple body systems.
What kind of medical provider should my child see for a
craniofacial abnormality?
The treatment of these disorders requires the involvement of
experts from multiple medical and surgical specialties (disciplines).
The American Cleft Palate-Craniofacial Association and cleft palate
associations worldwide agree that management of patients with
craniofacial anomalies is best provided by a multidisciplinary team of
specialists.
When should my child see a Craniofacial Team?
The optimal time for the first evaluation is within the first few
weeks of life. The focus of the team visit is to help correct the
patient’s physical problems as well as facilitate adaptation at each
stage of life as well. Usually your child will be seen at frequent
intervals as an infant and then on an annual or semi-annual basis.
What kind of medical providers will my child see on a
Craniofacial Team?
Most Cleft/Craniofacial Teams consist of
1) Plastic/Craniofacial Surgery: Surgeon with specialized training
in the diagnosis and treatment of skeletal abnormalities of the skull and
facial bones; will work closely with the orthodontists and other
specialists to plan and coordinate surgical plan.
2) Genetics: Evaluation includes review of the medical and family
history as well as examination of the child to help in diagnosis counsels
patient and family regarding risk for recurrence in future
pregnancies.
3) Nurse Team Coordinator: Registered nurse who combines experience
in pediatric nursing with specialization in the care of the craniofacial
patient and acts as liaison between the family and the craniofacial
team.
4) Dentistry/Orthodontics: Evaluates position and alignment of teeth
and coordinates treatment plan with the surgeon and other
specialists.
5) Otolaryngology/Audiology: Coordinates medical and surgical
therapy to normalize hearing as much as possible; directly involved with
evaluation and treatment of airway issues or problems.
6) Speech Pathology: Comprehensive speech evaluation to assess
communicative abilities; close monitoring throughout all developmental
stages.
7) Ophthalmology: Assessment and treatment of associated life eye
problems in coordination with other surgical interventions.
8) Neurosurgery: Coordinates surgical intervention of head
abnormalities with craniofacial surgeon. (i.e., craniosynostosis)
9) Social Services: Provides guidance and counseling for patient
and family in dealing with the social and emotional aspects of a CFA
diagnosis; assists family with community resources and referrals; (i.e.,
support groups)
10) Psychiatry: Assesses psychosocial function and behavioral
development; referral and therapy resources shared with family in
coordination with social services.
