61—MARYLEBONE JOURNAL
HEALTH
misshapen. Sometimes the eye doesn’t grow enough and occasionally the facial nerve is underdeveloped, which causes abnormalities in movement.” The treatment and management of
hemifacial microsomia usually goes on into the teenage years. “One of the problems of treating children is that if you operate on them at a very young age, sometimes the surgery can affect the way the face grows. So you are rather limited in what you can do.” Initially the craniofacial team
will undertake an assessment to ensure the baby is able to see, hear, breathe and feed normally. “If all of those functional things are fine, we probably wouldn’t do anything while they were a baby,” says Mr Dunaway. Throughout a child’s development
more and more specialists become involved with their care. “We need to make sure that all of those sensory things stay well protected,” says Mr Dunaway. “So there will be an ophthalmologist and ENT surgeon, and once the teeth start to develop we need to involve orthodontic care. When children approach school age there are issues around socialisation and psychological development, so they may need help from one of our psychologists. We may want to do some early surgery just to make things a little better while we wait for the process to go on. And then once they reach older childhood, and a permanent dentition is beginning to develop, we would start a series of surgeries to correct the problems they have.” Surgery is usually a staged process.
“If the jaws haven’t developed properly then we would make the jaws the right size and shape first so that the foundations of the face are right,” says Mr Dunaway. “If bits of jaw are missing then you may need to take bone grafts from other parts of the body. Ear reconstruction may involve taking cartilage from the ribs.”
Many babies are born with,
or quickly develop, some form of vascular anomaly. A haemangioma – strawberry mark – is an abnormality of blood vessels which usually appears shortly after birth and then increases in size. Fortunately most eventually disappear on their own accord. Yet some don’t go away. A
haemangioma can cause problems when it develops on the face. If close to the eye it may interfere with visual development. In these cases treatment is required. “You can give drugs like propranadol, which is actually used to treat blood pressure, but is quite effective in shrinking haemangiomas,” says Mr Dunaway. “Sometimes laser treatment is required, steroid injections, and for a small proportion of haemangiomas it’s necessary to remove them. Then it’s helpful to have a craniofacial surgeon so that we can deal with them in the best possible way and leave minimal scarring.” Mr Dunaway is also involved with
two international charities. Facing the World was set up to help children in the developing world who are severely disabled through their facial difference. “Part of the role of the charity is to bring children who couldn’t get treatment in their home country back to the UK, so that teams of craniofacial surgeons can help them,” says Mr Dunaway. “It also has a remit for education, so surgeons from developing countries visit us to learn how to undertake craniofacial surgery. And there’s also a project in Vietnam, where members of the team go out there to train the craniofacial unit.”
LINKS
152 Harley Street 152 Harley Street 020 7467 3000
152harleystreet.com
Our role is to make sure we maximise their functional potential, but also help them integrate into society and build up good relationships
The second charity, Facing Africa,
was set up to help victims of noma, an acute gangrenous infection affecting the face. Victims are mainly children under the age of six, caught in a vicious circle of poverty and chronic malnutrition. “I travel to Ethiopia once a year and lead a team to treat children with noma,” says Mr Dunaway. “We undertake some quite sophisticated reconstructive surgery to repair those defects. It’s an ongoing thing – lots of these children need multiple surgeries.” But the charity’s work doesn’t end
there. “The degree of ignorance about the disease is astounding,” says Mr Dunaway. Many people from these communities believe it’s due to a curse or believe it’s a transmissible infection. “These things really compound the problem about facial deformity, because if somebody thinks you are cursed and they might catch the curse from you, or if they think they might catch a disease from you, then you are isolated because people want to protect themselves from you.” Mr Dunaway stresses the need to
provide education. “Not only should you operate on the children, but you should follow things up and send health visitors to their home village to say: ‘This is an infection, it’s gone away, you can’t catch it. Don’t shun this person – they are a normal member of your society just like you.’”
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