Craniofacial Clinic

The Craniofacial Clinic is a multidisciplinary clinic whose focus is on treating children and youth with skull and facial differences.

How we help

The Craniofacial Clinic staff coordinates care for children with complex needs from the Maritimes. The team provides primary, secondary, and tertiary (specialized) care for children and youth requiring care and follow up for a wide variety of craniofacial conditions. Surgical and non-surgical methods are used to treat congenital disorders (existing from birth), tumours and traumatic injuries. The bones and soft tissues of the skull and face of growing children and youth are treated using a multidisciplinary approach that includes close monitoring and surgery. Surgical approaches range from minimally invasive endoscopic surgery to fat grafting to complex craniofacial reconstructive surgery involving reshaping the entire skull and facial skeleton.

Conditions we treat include the following:

• Nonsyndromic craniosynostosis-abnormal head shape due to isolated premature fusion of two segments of bone that make up the skull.
• Syndromic craniosynostosis-conditions that include a combination of craniosynostosis along with abnormalities that may involve the hands and feet, spine, eyes, facial bones and heart. These syndromes can lead to problems with increased pressure on the brain, visual impairment and breathing difficulties. Examples of such syndromes include Apert syndrome, Crouzon syndrome, Muenke syndrome and Pfeiffer syndrome.
• Positional plagiocephaly-abnormal head shape not caused by premature fusion of two segments of bone that make up the skull, but rather by a child’s head being in one position for an extended period of time. This can rise from a torticollis (wry neck) or from inadequate “tummy time”.
• Teacher-Collins syndrome-craniofacial syndrome characterized by down-slanting eyes, notched lower eyelids, underdevelopment or absence of cheekbones and part of the eye socket, underdevelopment of the lower jaw and undeveloped or malformed ears.
• Pierre Robin Syndrome-condition caused by underdevelopment of the lower jaw that leads to difficulties breathing and feeding. Children with this condition often have cleft palate too.
• Microtia-underdevelopment or absence of the external ear.
• Cranioifacial microsomia, a condition in which the lower half of one side of the face is underdeveloped and does not grow normally. The syndrome varies in severity, but always includes the maldevelopment of the ear and the lower jaw.
• Neurofibromatosis, an inherited condition in which patients develop multiple benign nerve tumours. Large tumours involving the face can lead to significant cosmetic and functional impairments .

Please note that although cleft lip and palate can be associated with many of the conditions listed above, if your child has only a cleft lip and palate and no other abnormalities their care will be provided by the Cleft Palate Team.

What to expect

The Craniofacial Team receives a consult from the family physician, emergency department, pediatrician or other specialists. The team will review the consult and determine the timeline for an appointment. The administrative support for the Craniofacial Team will notify you with an upcoming appointment date and time by phone and/or mail. If you’re unable to keep this appointment, please call the office to reschedule (470-7476).

The clinic nurse will contact you in the week prior to your appointment to review your needs for the appointment. The nurse will coordinate visits with other healthcare providers as needed to best address your needs or concerns. If you have any questions or concerns please contact the clinic nurse at 470-7904.

On the day of your appointment, please arrive in the Shared Clinics area located on the first floor of the Children’s building. Take a number and listen for your number to be called for registration. The administrative support will call your name and depending on you/your child’s appointment schedule you will be directed to a room or to another clinic area.

You must bring the child’s health card, a list of medications (drugs) that your child takes, and any toys or books that will entertain your child while you wait. Prior to your appointment it may be helpful to write down any questions you have. Some questions may include those related to activity level, pain management, feeding, and return to school or sports.

If this is your first visit to the clinic you can expect your appointment to take one to two hours. A follow up appointment is usually thirty minutes. Follow up care, if required, will be reviewed prior to leaving. The administrative assistant for the Craniofacial Team will notify you of follow up appointments by mail and/or a phone call.

While in the Craniofacial Clinic your child’s care may be provided by a resident (a doctor specializing in plastic surgery, neurosurgery or ENT surgery) or a nurse working under the guidance of the surgeons in the Clinic. Because your child may have complex problems that require the cooperation of different surgeons, your child may be seen by a neurosurgeon, craniofacial plastic surgeon, and/or ENT (ear nose and throat) surgeon during their visit. Each child is examined and assessed on an individual basis and after discussion with a parent or guardian a personalized plan of care is determined by the surgeons who will be caring for your child. Other healthcare providers will be consulted as necessary. Your child’s visit may include or be followed by diagnostic tests such as x-rays, blood work, or more specialized tests like MRI or CT scans. Every effort will be made to coordinate these tests with your appointment.

The IWK is a teaching hospital, so your visit may involve meeting with medical clerks (students), residents (physicians training to be a surgeon), surgical fellows (accredited surgeons doing additional subspecialty training in pediatric patients), and nursing students. Of course you will see your attending surgeons at every visit. 

Who you’ll meet

The surgical team 
This includes four surgeons who are responsible for assessing, examining, diagnosing and treating craniofacial problems your child may have (or deciding that your child does not have any problems). They also perform surgery, and will see your child in follow up appointments. 

Occupational therapist 
They may see your child to check his or her daily living skills and fine motor skills (small muscle movements, preschool and school related issues). Depending on your child’s needs, the therapist may provide direct treatment to your child, or suggestions for home and school.

Pediatrician 
They may see your child to check his or her growth and development and general health. The pediatrician’s focus is to help your child develop to their full potential. They will work together with the pediatrician or family physician in your community.

Social worker 
They’re available to the child and all family members as they adapt to the impact of the child’s health concerns. They can help your family with many issues.
Other specialties who may be involved in your children’s care during their visit include ophthalmology, neuropsychology, dentistry/oral surgery, and genetics.