Plastic and Reconstructive Surgery
Plastic and Reconstructive Surgery

The Section of Plastic and Reconstructive Surgery at Nationwide Children’s provides comprehensive management for all pediatric reconstructive needs including congenital and traumatic craniofacial and hand anomalies, velopharyngeal dysfunction, hemangiomas and vascular anomalies, pigmented birthmarks, reconstruction after burn injury, ear anomalies and breast deformities.

We are a unique institution in the number of truly collaborative, multidisciplinary programs within the Department of Surgery. In the Section of Plastic and Reconstructive Surgery, we are privileged to lead many of these programs, including leading the 22q Center and Cleft Lip and Palate Center.
Richard E. Kirschner, MD
Chief of Plastic and Reconstructive Surgery

As experts in 22q.11.2 deletion syndrome, we are positioned to provide diagnosis and early intervention services to optimize care and deliver best outcomes for every child. Given the wide spectrum of medical, developmental and psychological needs of patients with 22q.11.2 deletion syndrome, our individualized and comprehensive approach affords each child the opportunity to reach his or her full potential.

Other multidisciplinary programs include:

“Our team is focused on caring for the whole child,” says Dr. Kirschner. “We believe that true healing only occurs when we build caring relationships that address the physical and emotional aspects associated with a child’s condition.”

Nowhere is this more clearly exemplified than in the Cleft Lip and Palate Center. Our program offers children and their families comprehensive, coordinated care from a multidisciplinary team of nationally recognized clinicians. The team works together in order to optimize facial appearance, speech, dentofacial development and overall self-concept of every cleft-affected child. Beyond diagnoses and treatment, our team provides comprehensive educational and support programs for families and the community.

“We feel strongly that we should share our expertise and experience with others in order to maximize the impact we can make for children with clefts,” says Dr. Kirschner, who is also the co-editor of the textbook Comprehensive Cleft Care. “Our responsibility and obligation drive us to provide research and training opportunities for students, residents and fellows and to provide comprehensive services to underprivileged children in developing regions of the world.”

Training opportunities are available through our Pediatric Plastic Surgery and Craniofacial Speech Pathology fellowship programs. It is the goal of our programs to train the future leaders in cleft and craniofacial care through clinical training, didactic education and international experiences. Our trainees are devoted to excellence in pediatric care, research and education.

7,284 Clinic visits in 2015
1,216 Surgical cases in 2015
2 Fellowship/residency programs
4 Number of surgical faculty
Helping Teagan Thrive

When her twins were just a grainy image on an ultrasound, Jennifer’s doctor pointed out an important difference in their faces.

Teagan had a cleft lip. She would later be diagnosed with a cleft palate as well.

The discovery jolted Jennifer into constant worry. She feared what people would think when they saw her daughter’s face. And she would learn that babies with cleft lip and palate have a difficult time feeding because of the malformation. So how would she feed Teagan?

While still pregnant, Jennifer received help from the Cleft Lip and Palate Center Feeding Team at Nationwide Children’s. The team included a nurse, speech pathologist, nurse practitioner, dietician, social worker and surgeons.

By offering Jennifer consistent support and instruction, the team members ensured she was prepared physically, mentally and emotionally for the feeding challenges she would face. They made sure Jennifer had special bottles and nipples to try and had an understanding of techniques that would help Teagan eat. After Teagan was born, they continued to support and instruct Jennifer as she learned to feed her new baby.

In early infancy, Teagan was not gaining enough weight and was diagnosed with failure to thrive (FTT). Additionally, severe acid reflux left Teagan crying, gagging and spitting up after her meals.

“Teagan’s face would turn beet red, her eyes would bulge, and her whole body would stiffen,” says Jennifer. “I was very scared.”

With the help of the feeding team, Teagan’s reflux was managed with medication, and Jennifer learned effective ways to position Teagan during and after each feeding. She was also instructed on appropriate use of the special bottle-nipple systems and how to ensure Teagan had adequate nutrition to grow. Over the course of several months, Teagan’s weight gradually climbed into the 70th percentile.

Improving Feeding Outcomes for Babies with Clefts

The feeding team of the center was developed to support the needs of the approximately 75 newborns who enter the Cleft Lip and Palate Center each year and the families that care for them.

Babies with cleft palate are at risk for FTT because they expend too much energy trying to feed,” explains Courtney Hall, MS, CNP, pediatric nurse practitioner and clinical leader of the feeding team. “They expend more calories than they can consume with each meal.”

“Feeding a new baby can be stressful, even when there are no physical barriers,” says Adriane Baylis, PhD, CCC-SLP, speech scientist and quality improvement leader of the feeding team initiative. “For babies with cleft palate, feeding is the primary focus and stressor for families in the early months of life.”

Babies with cleft palate are rarely able to breastfeed directly to meet their nutritional requirements, and in some cases, children may need fortification of expressed breastmilk or formula to increase caloric density. Special nipples and bottles have been developed for infants with cleft palate to help deliver nutrition more efficiently. But even so, feeding problems can persist and parents may need additional medical support or resources to navigate them successfully.

Before the launch of the multidisciplinary feeding team and concentrated efforts around staff and patient education, the rate of FTT among nonsyndromic infants with cleft palate at the hospital was approximately 18 percent.

Upon the conclusion of the quality initiative, the rate of FTT among nonsyndromic patients with cleft has been sustained at 5 percent. The success of this effort reflects the collaboration and dedication of all feeding team members.
Adriane Baylis, PhD, CCC-SLP
Speech Scientist at Nationwide Children's

Feeding challenges can evolve as babies grow and reach new milestones.

For Teagan, introducing a sippy cup and solid food was also a challenge. The feeding team was there to help Jennifer learn how to support and accommodate Teagan’s changing needs and ensure she received proper nutrition.

“The goal of the feeding team is to ensure that babies with cleft lip and palate are growing and receiving adequate nutrition so that they are prepared for surgery,” says Dr. Baylis. “Nutritional status is one important indicator of readiness for surgery – the bigger, stronger and healthier before surgery, the better the recovery and, in some cases, the faster the child can be discharged home.”

When Teagan was four months old, she had her first surgery to repair her cleft lip. Later, she underwent surgery to repair her cleft palate. Now, as she nears her first birthday, she is eating soft solid foods and drinking liquid. Her reflux has dissipated as well.

“She seems more content,” says her mother. “And her smile is a particularly beautiful sight.”

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