Renee Kopkowski
Scottish Rite Children’s
Medical Center
Atlanta, Georgia

Clinical advances translate to better treatment and improved quality of life for patients.

Physicians at Scottish Rite Children’s Medical Center, Atlanta, Georgia, work to test new procedures and study better ways of treating children. They believe every option should be available. At the Center for Craniofacial Disorders, for example, groundbreaking work on procedures and treatments is being done every day on conditions ranging from cleft lip and palate disorders to skull deformities, disorders of the jaw, tumors, and trauma. The Center’s team of pediatric specialists includes clinicians from neurosurgery, genetics, orthodontics, dentistry, speech pathology, plastic and craniofacial surgery, clinical nutrition, occupational therapy, nursing, and audiology.

One of the most recent advances this team has made is with new equipment—bioresorbable plates and screws. Permanent, non-degradable, metallic plates and screws are typically used with bone grafts (when bone is inserted into bone to shape it correctly). These plates and screws help stabilize reconstructive surgeries, such as those to correct premature fusion of the skull, jaw and facial trauma, jaw deformities, or other reconstruction of the skull and face.

Bioresorbable plates and screws were used for the first time at Scottish Rite Children’s Medical Center in 1996 by craniofacial surgeon Steven Cohen, M.D., and pediatric neurosurgeon William Boydston, M.D., to treat children with excessive width between the eyes. The bioresorbable plates and screws represent a significant advance in reconstructive surgeries. They don’t require a second surgery for removal or interfere with x-rays, since the plates and screws are absorbed by the body within nine to 14 months. All these benefits make a serious surgical procedure easier on patients and their families.

Children with airway disorders are also benefiting from clinical care and research being conducted by the craniofacial team. In the past, children with craniofacial deformities have been evaluated primarily by how they look instead of from a functional point of view. Dr. Cohen and Fernando Burstein, M.D., co-directors of the Center for Craniofacial Disorders at Scottish Rite, have successfully treated over 75 children with obstructive sleep apnea and upper airway obstruction. By applying innovative surgical techniques and using pre-operative and post-operative sleep studies in these children, tracheostomies (surgical openings through the neck into the trachea to allow air to pass) have been avoided in many cases.

Working in close collaboration with John Riski, Ph.D., director of the speech pathology laboratory at Scottish Rite Children’s Medical Center, pediatric pulmonologists and a pediatric otolaryngologist, the patient’s breathing is carefully evaluated using computerized instrumentation, instruments used to view inside hollow organs (endoscopes), and radiographic imaging. Often, both speech and breathing can be improved with a single surgery. In the past, multiple surgeries have been necessary in these cases and many patients required a tracheostomy.

Another far-reaching process being pioneered at the Craniofacial Center is the technique to gradually lengthen facial bones, called distraction osteogenesis. Initially developed as external devices by Russian surgeon Ilizarov to correct problems in limbs from trauma and tumors, the technique was applied by Joseph McCarthy, M.D., at New York University to children with lower jaw disorders.

At Scottish Rite Children’s Medical Center, Dr. Cohen has expanded this concept beyond the region of the lower jaw and designed a number of devices that are temporarily implanted in the child’s facial bones to selectively and gradually move the mid-face, upper jaw, orbit and skull into desired position, growing new bone within those sites. Dr. Cohen performed the first total facial advancement with distraction in North America on a 9-month-old girl at Scottish Rite last year. Because of this work, children in the future may have large segments of the head and facial skeleton corrected with less invasive operations, thus sparing them significant trauma.

Making treatment easier for patients and their families is also a focus in the Neuroscience Department at Scottish Rite Children’s Medical Center. In particular, the department sees many patients with hydrocephalus. Hydrocephalus is a fluid build up inside the brain, often caused by excessive bleeding (hemorrhage) in a premature baby’s brain that blocks the baby’s ability to clear the brain of the spinal fluid it produces.

Hydrocephalus may cause irreversible damage to the brain unless it is treated. Standard treatment for hydrocephalus is placement of a shunt, a tube which drains the fluid out of the brain to another area (abdomen, heart, etc.) where it can be absorbed. The shunt is usually permanent and does have risks associated with it, including infection, further blockage, and stroke. Plus, most infants require further surgery to maintain their shunt as they grow. Right now, though, the shunt is the best form of treatment for hydrocephalus. For the Neuroscience team at Scottish Rite, that doesn’t mean it has to stay that way.

The team, under the lead of pediatric neurosurgeons Roger Hudgins, M.D., and William Boydston, M.D., is involved in a study of urokinase, a medication that dissolves blood clots. The goal of the study is to evaluate the safety and effectiveness of urokinase in the treatment of the hemorrhages that cause hydrocephalus in premature infants. The study also looks at the medication’s ability to prevent hydrocephalus from causing more complications, which may result in a permanent shunt for treatment. It stems from earlier studies in which the medication has been shown to reduce the need for shunts in infants.

Each of these clinical advances translates to better treatment and improved quality of life for the individual patients at Scottish Rite. But they mean so much more than that. They mean improved, more efficient health care for children in our communities, the country, and the world.

Since its founding in 1915, Scottish Rite Children’s Medical Center has been committed to preserving and improving the health of children and adolescents. Today, the Center’s main campus in north Atlanta and satellite facilities across metropolitan Atlanta provide general, specialty, and immediate care services for children from birth to age 21. Scottish Rite services can be accessed through RiteCall 404–250–KIDS. This free 24-hour pediatric health information line allows parents to talk with a nurse about their child’s health, schedule same-day appointments at Scottish Rite Immediate Care Centers, access recorded health information, and receive referrals to physicians. Scottish Rite provides additional pediatric health information through its Web site at www.scottishritechildrens.org.