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Department sections

• Cleft and Craniofacial Surgery
• Hand, Microvascular and General Paediatric Plastic Surgery 
• Oral and Maxillofacial Surgery 

CLEFT AND CRANIOFACIAL SURGERY

Cleft lip, cleft palate and craniofacial surgery involve the comprehensive treatment of children with congenital defects (birth defects) affecting their mouth, face and sometimes skull. A cleft is a "split" or "separation" which can occur anywhere in the body, but in these children occurs at the lip, nose or along the roof of the mouth. Craniofacial birth defects can be varied, but usually involve some aspect of an abnormally shaped skull. Clefts of the lip and palate are the most common congenital deformity of the face, affecting approximately one in every six hundred births. We do not know exactly why clefts occur but they do run in families to some extent. They are more common in Asian children and less common in African-American children.

As the child grows, many different parts of the face may be influenced by a cleft or abnormally shaped skull. Therefore, care of a cleft or craniofacial child involves a coordinated group of professionals who follow these children from birth until the completion of growth. That team consists of: plastic surgeons, paediatricians, geneticists, dentists, orthodontists, otolaryngologists, oral surgeons, speech therapists, audiologists, social workers and sometimes neurosurgeons and ophthalmologists.

	Craniofacial Clinic Our Craniofacial Clinic provides complete care and treatment for children with all types of craniofacial disorders.  This includes children with birth defects, deformity following trauma, or craniofacial growth disorders.  Our team brings together health professionals from many different fields to ensure that patients and their families receive the best care.  The team consists of plastic surgeons, dentists, ophthalmologists, anaesthetists, geneticists, orthodontists, photographers, orthotists (helmet remodelling), psychiatrists, social workers and specially trained nursing staff, both in theatre and the wards. Download Craniofacial Surgery Information booklet or Deformational Plagiocephaly pamphlet.
	Cleft Lip and Palate Clinic Our Cleft Lip and Palate Clinic here at the Royal Children's Hospital has a large and experienced group of specialists - plastic surgeons, oral and maxillofacial surgeons, ENT (Ear, Nose and Throat) surgeons, audiologists, paedodontists, orthodontists, otolaryngologists, speech pathologists, social workers and nurses - who combine to form the Cleft Lip and Palate Clinic. Download Cleft Lip & Palate - Questions & Answers booklet.

Section Chief - Anthony D. Holmes

HAND, MICROVASCULAR AND GENERAL PAEDIATRIC PLASTIC SURGERY

Our Department participates in a multidisciplinary team to reconstruct and rehabilitate patients with congenital hand and upper-extremity anomalies - hand problems present at birth or as a result of a trauma or infection involving the hand or upper limb. Anomalies include cerebral palsy, syndactyly (webbed fingers) and arthrogryposis (joint contractures). Other services provided by this clinic are microvascular surgery and distraction lengthening. Our General Paediatric Plastic Surgery service provides expertise in the treatment of common congenital hand anomalies, vascular birthmarks and malformations, paediatric burns, microsurgery and general paediatric plastic surgical problems.

Hand Clinic

Our Hand Clinic has evolved to meet the needs of children with upper limb disorders ranging from congenital anomalies, injuries, burns, neurological conditions, such as brachial plexus injuries and cerebral palsy, through to rare conditions.  These include inherited conditions such as epidermolysis bullosa, rheumatological conditions and vascular anomalies. 

The clinic is staffed by plastic surgeons, orthopaedic surgeons, occupational therapists, physiotherapists, orthotists and nursing staff all trained in the care of children with congenital and acquired conditions of the upper limb. 

Brachial Plexus Palsy Clinic Our Brachial Plexus Clinic is run by a multi-disciplinary team, headed by Bruce Johnstone. Your child will be seen by a physiotherapist from the clinic on a monthly basis and regularly by the clinic doctor throughout the first year of life.  Surgery will be recommended where appropriate.  Children who have ongoing problems or have been operated on are followed up by the physiotherapist and occupational therapist until school age and beyond.  Download Understanding Brachial Plexus Palsy booklet.

Microtia Clinic Our Microtia Clinic was developed by the Department in conjunction with the Department of Otolaryngology.  This specialist clinic enables a combined approach to treating patients with Microtia (underdeveloped or no ear) and other complex ear abnormalities.  The clinic is staffed by plastic surgeons and ear, nose and throat surgeons.  For more information, visit the Microtia Australia Support Group website. Download Microtia and Ear Anomalies booklet.

Saliva Control Clinic Drooling can be seen as a manifestation of many conditions.  For example, approximately 10% of patients with cerebral palsy suffer from drooling (sialorrhea). Drooling is normal in very young infants and toddlers, but in intellectually intact older children, it can have significant impact. Soiling of clothes and surroundings can cause emotional isolation and even physical problems with oral maceration and dehydration. Treatment options include a range of interventions. For some patients, no treatment is an appropriate recommendation. Young patients with no significant medical complications, good oral motor skills, who may improve with further maturation, can be carefully followed.  Patients with a low cognitive level or significant physical problems with a poor outlook for change may require other interventions. For some patients in whom other interventions are unsatisfactory, surgical intervention may be required. The most common procedure for the control of sialorrhea involves rerouting the ducts of the submandibular salivary glands to the tonsillar fossa. This reroutes the majority of the salivary flow posteriorly in the oral cavity allowing better control of sialorrhea through swallowing. Download Saliva Control In Children booklet.

Vascular Anomalies Clinic

Our Vascular Anomalies Clinic headed by Anthony Penington specialises in treatment of infants and children with vascular lesions. Hemangiomas and vascular malformations can be difficult to diagnose properly if one is not familiar with these lesions. Up to 50-60% of these lesions are diagnosed incorrectly, or are mistreated. While the uncomplicated hemangioma may be watched expectantly until it begins to involute, early intervention is often necessary and very beneficial for the more aggressive and complex vascular lesions. Our clinic provides the expertise to properly diagnose and recommend treatment and/or intervention for these lesions.

General Paediatric Plastic Surgery

Our General Paediatric Plastic Surgery service provides expertise in the treatment of common congenital hand anomalies, vascular birthmarks and malformations, paediatric burns, microsurgery and general paediatric plastic surgical problems.

Paediatric plastic surgeons provide treatment for the following:

• Birth defects of the ear (protruding or absent ear) 
• Birth defects of the chest and limbs (misshapen breasts, webbed fingers) 
• Injuries to the head, face, hands, arms, and legs 
• Birthmarks and scars 
• Burn reconstruction 
• Aesthetic surgery for deformities that may have psychological implications 
• Vascular anomalies
• Hemangiomas

Section Chief - Christopher J. Coombs

ORAL AND MAXILLOFACIAL SURGERY

Oral and maxillofacial surgery is a specialty encompassing the surgical and related treatment of diseases, injuries and deformities involving both the functional and aesthetic aspects of the head, face, mouth, teeth, gums, jaws, and neck.  This includes preventive, reconstructive, or emergency care for the teeth, mouth, jaws, and facial structures.

The paediatric and adolescent oral and maxillofacial service at the Royal Children's Hospital of Melbourne cares for children and adolescents born with congenital, developmental and acquired oral and facial deformities. The philosophy of our Section is to provide the highest level of care as an integrated component of a team approach.

Oral and Maxillofacial Clinic

Our oral and maxillofacial clinic cares for people with problem wisdom teeth, facial pain, and misaligned jaws.  Our surgeons treat accident victims suffering facial injuries, offering reconstructive and cosmetic solutions. They are concerned about helping children born with poorly shaped jaws and they care for patients with cancer. Their concern extends to their patients' total health.

Section Chief - Andrew A. Heggie