How to diagnose neonatal airway obstruction resulting from micrognathia and glossoptosis
Refering patients for multidisciplinary team evaluation
Managing the unstable airway in such children before, during and after mandibular distraction osteogenesis surgery.
This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.
CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™. Continuing Medical Education is also acceptable for meeting RN continuing education requirements, as long as the course is Category 1, and has been taken within the appropriate time frames.
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Since joining CHOC’s plastic surgery divison two years ago, Dr. Amber Leis and an expert multidisciplinary team at CHOC have developed a one-of-a-kind brachial plexus surgery program for children in the region and beyond. She is also working with her team to continue to expand services for children with facial paralysis, cerebral palsy and complex wounds.
A board-certified plastic and reconstructive surgeon, Dr. Leis treats everything from brachial plexus birth palsy, trigger thumb, syndactyly, and thumb hypoplasia, to ganglion cysts.
“I love the challenge of these cases, especially pediatric congenital hand anomalies, and I cherish the long-term relationship I build with patients,” she says.
Additionally, Dr. Leis is working on several research projects tied to brachial plexus reconstruction.
“One of these projects aims to gain consensus from experts around the globe regarding the management of specific nerve injury patterns. I spent some time in Toronto and Taipei this past year as part of this project. I am also working closely with our therapists to understand the way different rehabilitation techniques improve our outcomes,” she explains.
Dr. Leis’s interest in surgery dates back to her college years. “When I was in college I went to work in a hospital in Zimbabwe for four months to do research. While there, I ended up assisting in surgery. It changed my life, and I have been passionately pursuing surgery ever since. My parents were both artists, and I think surgery brought my life into harmony: being from an artistic home, and being a good scientist,” she says.
Dr. Leis attended medical school at Johns Hopkins University School of Medicine. She completed her residency in plastic surgery at Loma Linda University Medical Center, and a fellowship in orthopedic hand surgery at University of Southern California Keck School of Medicine.
Today, Dr. Leis’s philosophy for caring for her patients is compassionate and straightforward. She puts the emotional well-being of her patients first. Her highest priority is that they feel cared for and healed, she explains.
“My patients have such a deep strength to them. They allow me into their lives and let me be part of their healing journey. They have taught me about compassion, love, and the capacity to overcome,” she says.
Dr. Leis is a member of the American Association for Hand Surgery and the American Society of Plastic Surgeons, among other professional organizations. She has presented at many conferences throughout the country and published in various publications, such as the Annals of Plastic Surgery and Aesthetic Surgery Journal.
When she is not taking care of patients at CHOC or UC Irvine Medical Center, Dr. Leis loves spending time with her husband, a filmmaker. Together, they hike, travel and dabble in photography. She also enjoys running, drawing and baking.
A pediatric plastic surgeon specializing in reconstructive plastic surgery has joined CHOC. Dr. Raj Vyas sees patients with a variety of complex conditions including clefts and craniofacial anomalies.
“Care at CHOC is delivered in such a multidisciplinary fashion, allowing for complex higher-level discussions and nuanced treatment planning in both standard and exceptional circumstances. There is also an emphasis on safety and process improvement, both critical for a state-of-the-art facility serving a complex and diverse patient population,”Dr. Vyas says.
The Southern California native attended UCLA David Geffen School of Medicine. It was during his third year of medical school that he learned plastic surgery was his newfound passion.
“I unexpectedly fell in love with plastic surgery, particularly craniofacial surgery, after rotating on the service,” Dr. Vyas explains. “I had little appreciation for the depth or breath of plastic surgery before this experience. I remember seeing a child with hypertelorism undergo a facial bipartition and I was fascinated.”
Following medical school, he completed a plastic surgery residency in Boston at the Harvard Combined Plastic Surgery Residency Program. He then completed a craniofacial surgery fellowship at New York University Medical Center, in New York, where he treated children and adults undergoing facial reconstruction for congenital anomalies or after suffering trauma and cancer. He also gained expertise in microvascular surgery and virtual surgical planning.
Dr. Vyas is working with the team at CHOC to build a multidisciplinary program in facial reanimation. By combining craniofacial surgery with microsurgery, he hopes to restore facial form and function in children and teens with facial paralysis.
“We have a great team at CHOC. Dr. Daniel Jaffurs has been an incredible mentor,” Dr. Vyas says. “My goal is to help make the program the best in Southern California and beyond.”
Dr. Vyas enjoys working with virtual scanning and 3D modeling technology available at CHOC, as it helps him plan and ensure optimal safety and precision before a procedure.
“Today, we are able to use cone beam CTs to significantly minimize radiation exposure while still obtaining high quality 3D imaging. This allows for virtual surgical planning that is both precise and extremely effective in reducing uncertainty in the OR,” Dr. Vyas explains. “In neonates with upper airway obstruction, for instance, who are scheduled to undergo mandibular distraction, we are able to customize bony osteotomies in a way that prevents injury to dental structures and nerves, while optimizing distraction vectors that improve the airway and maintain cosmetic considerations. We can also virtually anticipate the extent of facial movements and design custom splints that facilitate orthognathic (upper and lower jaw) surgery. The benefit of these types of pre-planned procedures are expanding as surgeons utilize this technology in a variety of craniofacial reconstructions.”
When this dedicated physician is not busy helping patients at the hospital, he volunteers with Global Smile Foundation, a nonprofit organization that treats children with facial congenital deformities in underserved countries. Most recently he went to Trujillo, Peru, where he helped over 100 patients.
“It’s so rewarding to work with children,” he says. “Their reconstructions have a long-life impact.”
Dr.Vyas has given many national and international presentations and authored numerous book chapters and peer-reviewed articles in leading specialty journals. He is board certified in plastic surgery and a member of the American Society of Plastic Surgeons, American Society of Craniofacial Surgery, American Cleft Palate-Craniofacial Association and International Cleft Lip and Palate Foundation, among other professional organizations.
In his spare time, Dr. Vyas enjoys spending time with his wife. He also likes hiking, biking and playing tennis.
To refer a patient to CHOC, please call 1-888-770-2462. To contact Dr. Vyas, please call 1-844-827-8000 option #5.
Many babies are born with small blemishes—a little patch of redness here, a birthmark there. While these typically aren’t cause for concern, some cases may become problematic and require extra care.
“If a hemangioma is in a cosmetically sensitive area, or if it’s impairing vision, eating or hearing, it should be referred to a specialist,” according to CHOC plastic surgeon Daniel Jaffurs, MD. “A rapid-growing or large hemangioma should also be referred.”
When Casey Lang was born, she had two small marks on her body: one on her left cheek, and one on her abdomen. Doctors initially diagnosed it as a stork bite that would go away on its own. By the time Casey was two months old, however, the blemish on her face had become blotchy and was encroaching on her eye, and the growth on her abdomen had grown to the size of a lime.
Casey’s parents took her to her pediatrician, who referred her to Dr. Jaffurs. Immediately upon seeing Casey, he diagnosed the marks as infantile hemangiomas and consulted with the rest of the team from the CHOC Vascular Anomalies Center. They recommended that Casey be admitted to CHOC that day for comprehensive testing, to determine the severity of the hemangiomas.
“They started her on propranolol in the hospital and the journey started from there,” mom Michelle says. “It was a year on the medication, and we came to CHOC every single month. The medication was remarkable. It brought down the hemangioma on her face and opened up her eye.”
The growth on Casey’s stomach did not respond as well to the medication and was surgically removed by Dr. Jaffurs. What remained of the hemangioma on Casey’s face, however, could be treated with a simple procedure that had just become available at CHOC.
No Surgery, No Scar
CHOC’s new pulsed dye laser (PDL) is a minimally invasive treatment for hemangiomas, port-wine stains and post-surgical scarring anywhere on the body. The laser delivers very quick pulses of energy at a specific wavelength that is absorbed into the skin, destroying the abnormal blood vessels just below the surface. CHOC uses the latest PDL model—the Vbeam Perfecta— because of its level of precision, which is especially important when lasering sensitive areas like near the eye.
“With this new laser, we sometimes can avoid an operation which leaves a lasting scar,” Dr. Jaffurs says. “And, you can see the results immediately.”
CHOC’s pediatrics-trained anesthesiologists give patients a small amount of anesthesia using a mask, to relax them and minimize movement during the procedure. Patients are sent home the same day; side effects are very minimal and may include slight pain or bruising. The number of treatments needed depends on the location and size of the vascular anomaly.
Casey was one of the first patients at CHOC to be treated with the pulsed dye laser and after just two treatments, the hemangioma on her face is nearly gone. Most patients require three to five treatments depending on the severity of the malformation.
“I want other parents to know that if their child has this, there is a cure for them,” Michelle says. “The team they have at CHOC, it’s just amazing, and if you go there, you’re going to get answers.”
The CHOC Vascular Anomalies Center brings together pediatric specialists in hematology, plastic surgery, head and neck surgery (ENT), dermatology, cardiology and more to assess and treat all forms of vascular anomalies and malformations in children. For more information, call 714-509-3313.
The chances that a child will have a cleft lip or palate can increase if a parent, close relative or another sibling experienced the condition, but the increased risk is still small, Dr. Daniel Jaffurs, a CHOC plastic surgeon, tells “American Health Journal.”
Whether a child will experience clefting relies on a variety of factors, including prenatal care and genetics, Dr. Jaffurs says. Across races, Asians and Hispanics have higher rates, Africian-Americans almost never experience clefting, and Caucasian children fall in the middle of the spectrum of clefting frequency.
Learn more about diagnosis and treatment of this condition in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.
Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.
Dr. Jaffurs completed his medical training at the University of Pittsburgh. He did his internship and residency in general surgery at the Robert Packer Hospital in Sayre, Penn. The doctor completed a fellowship in plastic surgery at the University of Oklahoma, and a fellowship in pediatric plastic and craniofacial surgery at the Children’s Hospital of Wisconsin.
Get more information about referring patients to CHOC, including a referral information directory, services directory and referral guidelines.