Positional Skull Deformities

Positional skull deformities are frequently seen by Dr. Sundine. The incidence of positional skull deformities (deformational plagiocephaly) has significantly increased following the "Back to Sleep" recommendation from the American Academy of Pediatrics. Other causes of positional skull deformities include positional molding in the uterus, multiple gestation, and torticollis.

Physical findings include: a parallelogram shaped head when viewed from above, flatness on one side of the forehead with corresponding flatness on the opposite side of the back of the skull, the ear is pushed forward opposite the side of the flatness of the forehead. The diagnosis can usually be made from physical examination. In rare cases, a CT scan of the head may be required.

In many cases the treatment can be quite simple with positioning while the patient is sleeping. In some cases the child may require the use of a molding helmet that restricts growth in the prominent areas and allows for growth in the flattened areas. The best results from a molding helmet occur when the helmet is started before 6 months of age. Only in the cases of the most severe of deformities that have been refractory to molding helmet therapy would surgery be considered.

External Ear Deformities

Prominent Ears

Prominent ears are the result of an underdeveloped antihelical fold, conchal hypertrophy (large bowl of the ear), or a combination of the two problems. The treatment of prominent ears is to have an otoplasty performed. This procedure is done on patients around 5-7 years of age. At this age, the majority of ear growth is completed and the children start to become self conscious about the appearance of their ears.

The procedure is performed on an outpatient basis and takes around 2-2 1/2 hours to complete. The operation is performed completely from behind the ear so that there are no visible scars present. The resulting scar is in the crease behind the ear.

Microtia

Microtia refers to a small ear. There are different degrees of microtia-from a slightly small ear to complete absence of the ear. The condition usually affects only one side, but is occasionally bilateral.

Dr. Sundine typically employs a four stage technique for reconstruction of the ear. In the first stage, rib cartilage is harvested from the chest on the side opposite the affected ear. The cartilage is carved into a framework resembling the normal ear. The cartilage remnant on the affected side is removed and the framework is placed into a pocket under the skin to match the normal side. Patients stay in the hospital 1-2 days following the operation.

The subsequent operations are all performed on an outpatient basis. The second operation involves transposing the earlobule. In the third operation the ear is separated from the skull and a skin graft is applied from the buttock to the back of the reconstructed ear. The final operation involves harvesting skin and cartilage from the normal ear and using these materials to reconstruct the tragus. This operation also sets back the normal ear.

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.