NMCP: One of Two Pediatric Craniofacial Programs in DoD

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Story Number: NNS140805-12Release Date: 8/5/2014 1:50:00 PM

By Rebecca A. Perron, Naval Medical Center Portsmouth Public Affairs

PORTSMOUTH, Va. (NNS) -- In recognition of National Cleft and Craniofacial Awareness and Prevention Month, the craniofacial team at Naval Medical Center Portsmouth scheduled an additional monthly craniofacial board on Aug. 1 to meet with its patients.

Craniofacial anomalies are a diverse group of deformities of the head and facial bones that are present at birth. There are many variations; some are minor and some are severe requiring surgery. Many of NMCP's craniofacial patients are very young children.

During the monthly boards, about a dozen patients are able to see a full range of health care providers involved in their care all in one day, similar to a health care rodeo. Some are new patients, while others are receiving pre-surgical care or annual post-surgical follow ups.

At any given time, about 150 pediatric patients with craniofacial anomalies are cared for at NMCP by this team of highly specialized doctors. The program is fully accredited and the doctors are able to care for all craniofacial conditions. Anomalies range from cleft lip and cleft palate to hemifacial microsomia and craniosynostosis, all genetic conditions.

"We provide and coordinate comprehensive care for patients with craniofacial anomalies through the multi-disciplinary approach," said Cmdr. Maria Norbeck, team coordinator. "Our craniofacial team tailors individualized care plans to fit the needs of each patient and adjusts plans based on each patient's goals and development. We ensure quality of care and follow patients throughout their growth and development."

NMCP, along with Walter Reed National Military Medical Center, are the only two medical facilities in the Military Health System to be fully accredited to care for such conditions.

"These are flagship hospitals that have the full capability and capacity to care for all levels of complexity for children and adults with facial differences," said Air Force Lt. Col. Kerry Latham, co-director of NMCP's craniofacial board. "We have neurosurgeons who have a lot of training in pediatric neurosurgery who can do the cranial vault surgeries. We also have an excellent pediatric anesthesiologist and Pediatric Intensive Care Unit for post-operative care. We have every subspecialist here required to support the team."

Those subspecialists include a pediatric ear, nose and throat doctor, pediatric developmentalists, child behavioral psychologists and speech pathologists.

Latham is the only plastic surgeon in uniform who has completed additional fellowship training in craniofacial surgery. She is also the director of the board at Walter Reed, and as NMCP co-director, travels to Portsmouth for the monthly boards and to perform surgeries.

Cleft lip and cleft palate are the most common conditions treated. Sometimes, these and other craniofacial conditions are detected by ultrasound during pregnancy and the expectant mother begins the process with the boards before her baby is born.

"We offer prenatal counseling to these patients and give them information so they feel comfortable as they move forward," Latham said. "We can answer their questions even before their baby comes. It's rewarding how we can intervene and sort of meet the children before they are even here."

For Amanda Altobelli, she learned in May 2013, when her baby was two days old, that baby Mia had a soft cleft palate.

"Mia wouldn't latch when she was breast feeding," Altobelli said. "She wasn't able to form a suction. It's completely overwhelming at first, words can't even describe. So at two months, we started coming to the craniofacial board, doing some pre-op appointments to get ready for surgery. By meeting with the board as soon as possible, it puts a lot of questions behind you.

"Then the surgery was fantastic," Altobelli added. "We were extremely pleased with the team."

Surgery was performed on Mia in January when she was eight months old. Now 14 months, Mia receives weekly speech and feeding therapy.

"We were so blessed that this team has been placed with us," said Chief Electronics Technician (SW/EXW) Daniel Altobelli, Afloat Training Group Norfolk. "Trust in the doctors here at Portsmouth, because they are fantastic. You are a patient, not a number. They really take it case by case."

Mia will come to the board each summer for follow-up care, ensuring the muscles and tissue are developing correctly and that there are no complications. Cleft lip and cleft palate patients are followed until age 18.

"We won't know how their smile looks until they have their permanent dentition as a teenager," Latham said. "We watch them grow and see what their needs are - emotionally, functionally, physically - to see what services we can provide along the way."

Patients with hemifacial microsomia are also followed into their teens. This condition is essentially an asymmetric growth of the face. There can be jaw, facial-bone and soft-tissue asymmetry, as well as nerve weakness of one half of the face and failure for an ear to develop.

"Sometimes these children benefit from surgery at different times in their life, depending on their growth and development and their functional needs," Latham said. "It's a pretty common condition that we treat. We also see patients with craniosynostosis, which is a premature fusion of the skull bone. There are growth plates in an infant's skull to accommodate rapid brain development. If the plates close early, it can lead to an abnormal head shape. We follow these patients until age 10, and if there have been no issues, we can graduate them from the board."

Despite the level of complexity of conditions of the 150 patients at NMCP and the 150 patients at Walter Reed, Latham said they all have something in common - resiliency.

"It's so amazing to work with these families," Latham said. "To be able to support them and see how resilient the military families are, and how resilient these kids are, and what great things they go on to do is really just amazing. Our team really enjoys taking care of these families. These two teams of providers are also really amazing."

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.

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