Choosing a Surgeon for Your Child

Team Approach

Most cleft and craniofacial conditions affect multiple aspects of your child’s anatomy and their health. They require the input and care from many different specialists. If these specialists don’t work together, they can actually do things out of order and complicate the care of your child. Consequently, this leads to unnecessary procedures and makes future interventions harder to do. Long ago, specialists recognized the need for a team approach and coordinated care. They established the American Cleft Palate and Craniofacial Association (ACPA). This organization developed standards for specialists involved in a cleft and craniofacial team. Additionally, the ACPA certifies teams who have all the essential specialists and can demonstrate their use of them. When choosing a surgeon, find out if they practice a team approach and if their team is certified by the ACPA. If so, do they hold regular interdisciplinary team meetings? It is also important to know that the ACPA certification does not look at outcomes and practices of the team. It simply lets you know if the team has all the resources that should be available for complete cleft and craniofacial care. It is possible to get less than ideal care from an ACPA certified team. It is a good idea to get to know other families in your area and find out what their experience has been with local teams.

Experience

There is something to be said for the experience of your surgeon and their team. Experience comes from many different places and shouldn’t simply be a matter of how old they are or how many years they have been practicing. There are older surgeons who may only dabble in cleft and craniofacial work or only do a few procedures each year. You may also find surgeons who are practicing out of date techniques because they have not stayed current with developing care. Experience is a sum of the amount of exposure they have had with cleft and craniofacial conditions in life, schooling, residency/fellowship training, and in their current practice. While it is important that a surgeon and team can perform a surgery well, it is just as important for them to know what type of surgery to perform, when to perform it, and what other procedures to combine it with. We have seen beautifully performed procedures that were unfortunately done for the wrong indication or at the wrong time and resulted in very bad outcomes for the child. Your surgeon and team should have solid training, frequently attend conferences specific to cleft and craniofacial care, perform these procedures frequently, and have a track record of good comprehensive care. Also make sure that the team members are passionate specialists in treating kids with clefts and craniofacial conditions and not just people who are filling a spot on the team roster.

Treatment Timeline

As mentioned above, cleft and craniofacial care should be well coordinated with other specialists with the goal to keep children out of the operating room as much as possible. There is increasing literature describing PTSD type symptoms in children who have to undergo multiple surgical interventions during childhood. There is also data showing that frequent childhood anesthetics can have an impact on development. A well-organized team will have a treatment timeline that combines surgical interventions under each anesthetic and space out the time between these as much as possible. Teams without an organized approach will often do too many procedures that can negatively affect development, increase anxiety, and increase scar tissue that may require more interventions to correct. Don’t be afraid to ask your team for their specific timeline.

Type of Surgeon

There are several different specialties that offer cleft and craniofacial care. Plastic Surgeons, ENTs, and Oral and Maxillofacial Surgeons are the most common. Traditionally, plastic surgeons were the pioneers to develop modern day cleft and craniofacial care and this care is part of their board certification. Most plastic surgeons who wish to specialize in cleft and craniofacial care will do additional fellowship training performing high volumes of these cases. Recently, interested ENTs and Oral and Maxillofacial surgeons have started treating these conditions with or without additional fellowship training. Regardless of discipline, you want to find a surgeon who is passionate, well trained, surgically talented, subscribes to a team-based treatment approach, and dedicates a significant part of their practice to treatment of these conditions.

We are often asked if it is okay for a cleft surgeon to also perform cosmetic surgery. The insurance reimbursement for most cleft and craniofacial procedures is not very much and given the amount of time and number of employees it takes to coordinate care, it can be very difficult to keep a private practice going financially. This requires most private practice cleft and craniofacial surgeons to perform higher paying procedures or cosmetic surgery on the side. Surgeons who work for Universities and other hospital-owned practices are often subsidized by more lucrative departments and therefore don’t have to do any cosmetic work. Surgeons who also do cosmetic surgery are known for a sharp attention to detail and this should not be thought of as a negative factor. The key is to find a cleft and craniofacial surgeon who does a little cosmetic surgery and not a cosmetic surgeon who does a little cleft and craniofacial surgery. Private practice craniofacial surgeons are known for their passion given that they could make a lot more money doing purely cosmetics but choose to make less in order to treat these children and their families.

Insurance & Facilities

Often times you will be told by your insurance company who you can see and in what facility your child can be treated. This is important to find out as it can be very costly to seek care outside of these networks. There are almost always benefits that can be used to see providers outside your network, but generally have a different deductible and more out of pocket expenses. Find out where your surgeon has operating privileges and make sure they have access to hospitals with higher levels of care. If anything were to go wrong, you want to make sure your surgeon can also treat you in a hospital with needed resources.