Craniofacial Syndromes
There are a number of different syndromes that involve that head and neck that are treated by Dr. Sundine.
Craniofacial Dysostosis Syndromes
These syndromes are characterized by craniosynostosis (usually bilateral coronal craniosynostosis), midfacial hypoplasia (retruded cheek bones and upper jaw), and the possible presence of extremity anomalies.
Some of the syndromes include:
Crouzon syndrome
Apert sydrome
Pfeiffer syndrome
The treatment of these patients is often staged. The early treatment is dedicated to the treatment of the craniosynostosis. Later treatment is usually oriented to advancement of the midface and jaw surgery.
Hemifacial Microsomia and Goldenhar syndrome
These syndromes affect the growth of the structures of the face. It may involve the eye socket that may be small or displaced, the ears may be small or underdeveloped (microtia), there may be tilting of the bite (upper and lower jaw) upward and the mandible may be underdeveloped. There may also be lateral facial clefts. Goldenhar syndrome includes the facial spectrum of hemifacial microsomia along with dermoid cysts involving the eye.
Treacher Collins syndrome and Nager syndrome
Both of these syndromes involve both sides of the face. The areas involved include the cheekbones, ears, and jaws. Some of the facial findings include: hypoplasia of the malar area (flattened cheekbones), antimongoloid slant of the eyelids (downward slope of the eyelids), notching of the lower eyelids, absent eyelashes on the inner eyelids, microtia (small or absent ears), and mandibular hypoplasia (retruded mandible). In patients with Nager syndrome there are also hand deformities.
The early treatment is directed to protection of the eyes and lengthening of the mandible to try to avoid tracheostomy. Subsequent procedures involve correction of the ear deformity, reconstruction of the cheekbone, and further treatment of the jaw deformities.
Frontonasal Dysplasia and Hypertelorism
Hypertelorism is a condition characterized by an increased distance between the orbits (eye sockets). This uncommon condition is caused by frontonasal dysplasia, facial clefts, craniofacial dysostosis syndromes, meningoencephaloceles, and intracranial tumors.
The treatment of this condition is directed to narrowing the distance between the eye sockets with a combined craniofacial and neurosurgical procedure.
Turner syndrome
Patients with condition are characterized by a webbed neck deformity and a low posterior hairline. Both of these problems may be addressed with an operation performed on the back of the neck.
Dr. Sundine has had a longstanding interest in the treatment of complex congenital deformities in children. In addition to his extensive plastic surgery training, he also completed a fellowship in craniomaxillofacial surgery at the Hospital for Sick Children in Toronto, Canada. Dr. Sundine is the Medical Director of Pediatric Plastic Surgery at the Children's Hospital of Orange County. He actively participates in the Cleft/Craniofacial Team at the Children's Hospital.
