60—MARYLEBONE JOURNAL HEALTH
FACE THE FUTURE JEAN-PAUL AUBIN-PARVU LOOKS AT THE COMPLEX CHALLENGES OF CRANIOFACIAL SURGERY
We are often judged by appearances. So imagine how hard it must be to live with a facial deformity – especially for a child. Hard on a number of levels, because a facial deformity can present functional problems affecting sight, hearing, speech and breathing. And then there are the social and psychological problems. “Children who have facial
difference, if they’re not very well supported, can run into a number of problems with stigmatisation and integrating themselves into society,” says Mr David Dunaway, co-founder and director of the specialist plastic surgery unit at 152 Harley Street. “So our role is to make sure we maximise their functional potential, but also help them integrate into society and build up good relationships.” Mr Dunaway is a consultant plastic
surgeon whose specialisms include craniofacial reconstruction and paediatric plastic surgery. His NHS practice is based at Great Ormond Street, where he leads the craniofacial unit. He is also a member of the craniofacial team at University College London Hospital. 152 Harley Street is one of the few
private hospitals to treat children. The craniofacial team see children with a range of deformities of the face and head and are able to perform simple treatments under local anaesthetic.
“Much of their care is co-ordinated by our team here, and it’s a very friendly environment for children,” says Mr Dunaway. “Where more complicated procedures are required – many children with complex craniofacial problems need big teams, intensive care units – we would either treat them at The Portland Hospital or at Great Ormond Street.” Deformities of the face and head
can be caused by birth defects, trauma or treatment of tumours. There is a whole spectrum of congenital craniofacial defects, the most common being the cleft lip and palate. A cleft lip is a split in the upper lip, while a cleft palate is a split in the roof of the mouth. They occur during early development in the womb, when the upper lip or palate doesn’t join together properly. A cleft lip is usually repaired surgically at around the age of three months, while for a cleft palate it’s usually between six and 15 months. As the child grows up, speech therapy may be required. Hemifacial microsomia, the
second most common facial anomaly, is an underdevelopment of one side of the face. It can affect the jaws, eye, ear, skin and nerves. Often the jaws on the affected side are underdeveloped and sometimes a normal joint does not form. “Quite commonly the ear on the affected side doesn’t develop normally – it can be completely missing or just
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