Congenital Anomalies

EYELID FALLS (PITOSIS):

The "lowerpositioning" of the upper eyelids is called pitosis (eye lid falls).
The lower border of a normal eyelid is situated 1 to 2 mm lower than the
superior arcus of the cornea on direct gaze. Various syndromes or affected
regions of the body can be encountered with pitosis which can have congenital or
acquired reasons, so the patient should be examined intensely by a specialised
plastic and reconstructive surgeon.

Surgically hanging, the excision of the excess tissues and reconstrcution or
shortening of the eyelids by suturation techniques(plication) are possible
treatment modalities that can culminate in excellent functional and aesthetic
results.

HAND ANOMALIES:

A significant deformity affecting the upper extremity results in emotionally
charged experiences for the parents looking forward to having a newborn with
happiness and excitement. The parents feeling guilty for the future and anxiety
mixed up with anger sink into despair for the reasons and results of the
deformity. To overcome the fear of the parents, the patient should be evaluated
by a hand surgeon in the early period.

The deformity can have a perspective between unimportant states; possessing
unpropotional hands and important states; being functionally handicapped. The
timing for the surgical intervention is decided by the surgeon according to the
situation. In some instances (eg. The constriction bands of hand), very early
intervention is necessary but, in differents cases, the operation should be
postponed until the age of 8.(eg. Tendon graftng or transfers)

The hand anomalies, classified as the cessation of development or
differentiation, over or under growth, duplication, congenital constriction or
general skletal anomalies, can be treated successfully by a specialised plastic
and reconstrcutive surgeon.

HYPOSPADIAS:

Hipospadias is a congentital deformity, known as the prophet circumcision. In
these patients, the urination orifice is mislocated somewhere under the penis,
instead of its normal place. These children urinate towards their feet, and if
not treated, loss of reproductive abilities can be a problem in the adulthood.
The optimum timimg for the operation is 4-6 years of age. The patient is
controlled twice a year until the operation.The first rule in hypospadias is
that the parents should avoid circumcision. The surgical interventions to the
cases which are late-recognised, can be more complicated and difficult.

There are various operation techniques that can be committed by a plastic and
reconstructive surgeon easily. The "uretrocutaneous advancement" or Şensöz
technique is one of those accepted and being utilised widely throughout the
world and can achieve good functional results and patient satisfaction.

CLEFT LIPS AND CLEFT PALATES:

Cleft lip and cleft palates are one of the most commonly seen natal
abnormalities in our country. The sequence of these abnormalities is stated to
be once in 665-762 births in the classical books. This percentage can increase
up to 2% if any of the parents has, and up to 14% if both of the parents have
this abnormality. These rates increase also due to the marriages between the
relatives, which can still be seen in our country. Cleft lips and cleft palates
are situations that bring unhappiness together with a deep anxiety to both the
family and the relatives with the birth of the child. The parents worry about
not only the physical appearance but also the IQ level of the child.

These abnormalities which can be seen either together or separately, are not
related to child’s general condition of health or IQ level except for rare
situations, despite their dramatic physical appearance. Moreover, it would not
be wrong to say that these children are more likely to be friendly and clever
when they grow up. These children are also successfully treated. We can
successfully operate both cleft lips and cleft palates using the operation
techniques, which are accepted and applied, all around the world.

The ideal operation time for the cleft lips is when the child is 3 months old
and for the cleft palates, it is when the child is 10-12 months old though it
changes according to the location.

For the cleft lips, in addition to the operation in the third month after birth,
aesthetic operations are added to the treatment right before the child starts
school, at the age of 11 and at the age of 16 for the remaining traces over the
lip or the nasal asymmetries that can occur in different degrees. For the cleft
palate, the operation in the tenth or twelfth month is enough for the treatment,
however, the child should be taken under the control of the professional
institutions for speaking problems.

Unfortunately, the most important problems which stems from the lack of
education in our country is, the patients’ being brought extremely late for the
treatment. This has a critical importance as follows;

The cleft palate patients may become face to face with untreatable problems if
they are brought after the twelfth month or especially after they start to talk.
Because, cleft palate also involves some problems in the soft palate muscles in
addition to the bones, which provide the pronuonciation of the letters such as
"k" and "g" by closing the link between the mouth and the nasal space depending
on the cleft.

If the cleft palate is not operated before the beginning of speech, and the
patient starts to talk in such a condition, permanent inadequacies occur in
these muscles and even if the cleft is operated after this step, permanent
disorders in the ability of speech occurs.

Timing is also important for the cleft lips, because, the more the child grows
up, the more difficult the operation gets and parallel to this, the results
become less satisfactory.

If parents observe such an abnormality on their child, they should immediately
apply to a professional centre and have their children taken under control. With
these kind of immediate surgical treatments, these abnormalities will not have
any negative physical or social effects on the child’s future life.

NATAL EAR ABSENCE:

The whole or partial absence of one ear or both ears are situations that often
come across in the plastic surgery centres.The functionally or aesthetically
proper construction of ears, which have an important role in a person’s life
both functionally and aesthetically as a part of human face, is of utmost
importance. The applied operation, which is also accepted worldwide, consists of
two steps. As it is known, what gives its shape to the ear is the cartilage part
that is under the skin.

This ear cartilage provides the shape of all the curves in the ear. Therefore,
the most important point of the treatment is to construct a frame that will take
the place of this cartilage. The second important point is the skin
reinforcement, which will occur after the construction of the absent part. This
operation which consists of two steps should be applied at the ages of 5-6 when
the ear growth is completed(85-90%). The operation technique is simply as
follows;

Among all the different techniques that are used to form the frame that will
shape the ear, the most commonly applied one is the using of a synthetic
material (medpore) or a piece of cartilage that can easily be taken from the
cartilage parts of the ribs. After the material is chosen, it needs to be shaped.
In the absence of single ear, the frame is shaped according to the shape of the
other ear. In the absence of both ears, since there isn’t a shape that can be
taken as example, the material is shaped by taking the mother’s ear as the
model. After that step, the frame is placed under the skin where the ear should
be situated.

After this first session, the frame adapts to its new place in a couple of
months. In the second step, this frame is lifted up in a way that there are some
tissue under it. In this situation, there is the absence of skin both at the
backside of the ear, which is newly constructed, and in the place that the frame
is lifted. The reinforcement of this is very easy and with a special tool called
dermatome, skin grafts are taken from the thighs according to the size of the
required skin, and are placed where necessary. The post-operative appearance of
the ear is an swollen ladle shape, however this appearance disappears in 6-12
months after the skin adapts to the frame, the curves get clear and the swollen
ladle shape totally disappears.

As it can be seen from the pictures, the results are extremely satisfactory for
the people to get rid of their problems. Since satisfactory results can be taken
despite the long period of treatment, it is the parents’ responsibility to have
the natal ear absence treated at the appropriate age.