MDNews - Minnesota

plastic surgeons and a microsurgeon. We recruited Cheryl Anderson-Cermin, DDS, one of the two foremost cleft orthodontists in the country. Speech issues are addressed by Kelly Nett Cordero, [PhD, CCC, SLP,] a bilingual speech and language pathologist. Our outcomes reflect this high caliber of excellence and focused expertise." "Having this high level of expertise available in one location often allows for evaluation, diagnosis and treatment recommendations in the same visit," notes craniofacial surgeon Martin Lacey, MD. "This is particularly important for families traveling significant distances." Parents are often anxious about their children's conditions and want quick access to specialists. "With Gillette's depth of providers and clinic services available at the main cam- pus in St. Paul and at clinic locations in Burnsville, Maple Grove and Minnetonka, we can get children in to see us very quickly," Dr. Lacey says. Craniofacial Treatments at the Leading Edge of Medical Advances Cleft Lip and Palate One in 700 infants is born with cleft lip and palate. Gillette's experts in plastic surgery, orthodontics and speech combine their talents to maximize cosmetic and medical outcomes for each child. Early consultation is crucial. "For these children, the best shot at get- ting a socially unnoticeable repair is during the first surgery," explains plastic surgeon Paul Lim, MD. The orthodontic phase of cleft treatment ideally begins within the first week of life. "All of the anatomical components are there on these babies," Dr. Anderson-Cermin explains. "They just aren't in the right places. In the orthodontic phase of treatment, I make a plastic acrylic device, called the Gillette OrthoCleft retainer, to shape and mold the maxilla of the upper jaw prior to surgery. The infant wears this device — which is refitted every week — from the first week of life through lip surgery at three months. The retainer improves tongue posture and manipulates the maxilla so babies feed better and there's increased psychological bonding between mother and child. Effective preoperative molding sets the child up for a more successful surgery and fewer surgeries and revisions down the road." Surgery to repair the lip is followed by a palate-correction surgery at nine months. Cordero consults with the surgical team to monitor the speech aspects of cleft repairs, and she attests to the importance of surgical expertise through the repair process. "Sometimes, after the first surgery, we'll use a secondary procedure called a pharyngeal flap surgery to correct nasality in a child's speech," Cordero says. "Colleagues at other institutions will ask me what I recommend in cases when my surgeon's pha- ryngeal flap fails or falls apart. I don't know what to tell them, because since I've been at Gillette, I can't remember that happening. We might tweak a flap, but that's very different from a failed surgery. Our institution's consistency speaks to our surgical expertise." Craniosynostosis This congenital condition affects one in 2,000 infants, causing premature fusion of the bones in the skull. Unlike plagio- cephaly, untreated craniosynostosis can result in developmental delays, permanent brain damage and death. The treatment is cranial vault remodeling surgery, which is performed at four to eight months by a neu- rosurgeon and craniofacial surgeon. During the surgery, the sutures are separated, and the bones are reshaped, repositioned and held in place with resorbable fixation. Dr. Wood identifies the introduction of resorbable fixation technology — in which ultrasonic rivets and dissolving plates replace traditional plates and screws — as the most significant surgical advance in this procedure. Resorbable fixation increases the speed with which the operation can be completed, and it plays a major role in achieving the highest goal of cranial vault remodeling: transfusion-less surgery. "Without a blood transfusion, we avoid risk of blood-borne pathogens, prions, transfusion reactions and fevers that extend hospitalization," Dr. Wood says. "Of the past 20 cranial v a u l t p r o - cedu res we p e r f o r m e d , 10 were done without trans- fusing. Going forward, we hope to per- form 75 percent of these operations without transfusions." Dr. Lim explains that speed and efficiency are critical to achieving transfusion- less procedures. "The need for transfusion hinges on the expertise and ability of the individual surgeon," he notes. "The standard time for this procedure is four hours; Dr. Wood completes the entire operation in two hours." Plagiocephaly and Torticollis The incidence of plagiocephaly, or flattened head, in infants is common and increasing. Dr. Wood estimates that he sees approximately 20 cases each week. Approximately half of the cases are accom- panied by torticollis, a tightening of the muscles on one side of the head. Gillette has developed the FDA-approved Gillette CranioCap orthosis, an orthotic molding helmet and treatment protocol for effective management of children who have plagiocephaly. Gillette's certified orthotists optically scan each child's head and fit the Robert Wood, MD Martin Lacey, MD Cheryl Anderson-Cermin, DDS Paul Lim, MD Kelly Nett Cordero, PhD, CCC, SLP M D N E W S . CO M ■ MD NEWS Minnesota | 7

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