Plastic Surgery - UT Southwestern Medical Center

The Division of Plastic Surgery at UT Southwestern / Children's Medical Center of Dallas offers a (12) month fellowship program in Pediatric Craniofacial Surgery. This fellow is a fully integrated member of a team that currently performs 600-700 procedures each year. Pediatric Craniofacial Surgical procedures are increasingly performed on smaller and younger patients, necessitating specialized training opportunities. None of the plastic surgery subspecialty societies currently approves or accredits pediatric plastic surgery craniofacial fellowships. This position is typically offered to physicians who have successful completion of three to five years of general surgery training and two to five years plastic surgery training and are looking for more complete training in pediatric plastic craniofacial surgery.

Goals and Objectives of the Pediatric Plastic Craniofacial Surgery Program

The goal of the program is to educate and train future academic, clinical, and research leaders in pediatric plastic craniofacial surgery. Upon completion of the training program, the surgeon should have clinical expertise in all aspects of pre, intra, and postoperative craniofacial surgical management for infants, children, and young adults. The vast majority of defects and management issues for these patients are outside the scope of adult plastic surgery practice, and are usually only covered for several months in most adult plastic surgery training programs.

• In-depth study of pediatric disorders of the soft and hard tissues of the face and cranial areas, such as congenital anomalies, post-traumatic, and other acquired deformities
• In-depth and comprehensive "mentorship" experience with the preoperative evaluation, treatment planning, operative treatment, and postoperative management of pediatric patients with congenital and acquired craniofacial and pediatric plastic surgery diagnoses.
• Pre- and postoperative intensive care unit management of complex craniofacial malformations: ventilator, inotrope and fluid management, and hemodynamic assessment.
• Participation in the diagnosis, planning, operative treatment, and postoperative care of craniofacial diagnoses including: craniosynostosis, midface hypoplasia, facial symmetries, Treacher Collins syndrome, Craniofacial Microsomia, congenital and traumatic orbital dysmorphologies, craniofacial clefting and orbital hypertelorism, atrophic and hypertrophic disorders such as Romberg's disease and hemifacial hypertrophy, craniofacial bony neoplasms such as fibrous dysplasia and osteomas, neurofibromatosis, vascular anomalies, post traumatic craniofacial deformities, and craniofacial exposures in cranial base surgery
• Involvement with an interdisciplinary pediatric cleft-craniofacial team, with formal exposure to team members and their respective roles.
• Experience in the surgical correction of congenital clefts of the lip and palate both primary and secondary repairs and revisions
• Experience in reconstructive management of defects after ablative surgery for malignancy of the craniomaxillofacial region
• Formal experience with pediatric otolaryngology, focusing on difficult airways.
• Formal experience with oral and maxillofacial surgery, focusing on cephalometric analysis, fabrication of dental models and orthagnathic splints, surgical treatment planning, and orthagnathic surgery.
• Formal experience with the reconstructive management of post-ablative defects from malignancy about the craniomaxillofacial region with free flap surgery and bone grafting techniques.
• Formal experience with pediatric craniomaxillofacial trauma, both acute and post-traumatic deformity reconstruction.
• Coordinate the development and use of radiologic equipment including: three dimensional CT scan, three dimensional MRI, and computer surgical planning
• Coordinate helmet protocol between craniofacial team, radiology and prosthetics-orthotics program.
• Participation in clinical research and become involved in teaching in both didactic and informal conferences to the residents in plastic surgery and on the clinical services. In addition to the departmental plastic surgery conferences (devoted to pediatric plastic surgery), there is active participation in regularly scheduled clinical pediatric conferences including Grand Rounds, team craniofacial conferences and at least one regional or national craniofacial conference.
• Weekly outpatient clinic experience in the preoperative evaluation and postoperative management of pediatric craniofacial patients.

Program Curriculum / Required Scholarly Activities

The fellow will have progressive responsibility based on experience and capability. All rotations will be at Children's Medical Center of Dallas. The operative experience will be determined by the fellow's ability and understanding of the complexities of pediatric craniofacial surgery. It will be designed toward gradual, but progressive responsibility commensurate with the fellow's training and surgical expertise.

Fellows will participate in the operating room on a daily basis. Fellows will assist the attending surgeon or perform major surgery (cleft lip and palate, craniosynostosis surgery, orthognathic surgery, microvascular surgery, trauma surgery, and other craniofacial and pediatric plastic surgery procedures) in infants and children. They will be expected to understand fully the anatomy, physiology, and planning of major craniofacial surgery reconstructions as well as the technical performance of these complex procedures. A thorough understanding of the anatomy and physiology will be gained through operative experience, individual study, didactic conferences, and direct communication with the program director.

Clinical education is primarily derived from lectures and rounds as well as in the course of the pediatric craniofacial surgery fellow's clinical duties, and interacting with the attending staff in plastic surgery. Numerous special conferences are also designed primarily for the instruction of plastic surgery residents and fellows. When not involved in clinical activities, fellows are expected to attend all pediatric plastic craniofacial surgery program academic activities throughout the year. Additionally, fellows are required to be involved in the education of the residents and medical students rotating through the service.

• Demonstrate knowledge of normal and abnormal embryology and fetal development of the head and neck
• Demonstrate ability to interpret radiological studies including dental radiographs, cephalometric analysis, CT and MRI imaging modalities
• Demonstrate expertise in the construction of pediatric dental study models, orthagnathic splints, and their use in craniofacial and maxillofacial surgery
• Appreciate the standards of cephalometric normalcy as they relate to the face
• Demonstrate an understanding of bone healing, including primary healing, malunion, nonunion, osteomyelitis, and the physiology and methods of bone grafting.
• Demonstrate an understanding of the use of alloplastic materials in craniofacial reconstruction
• Demonstrate knowledge of congenital, developmental, and secondary deformities of the head and face
• Participation in programmatic conferences including journal club, morbidity and mortality rounds, weekly surgical case review.
• Preparation of presentations for national and/or international professional meetings.

Fellows will be expected to initiate and complete at least one clinical and one basic science research project during their training. These will be facilitated by pediatric plastic surgery faculty members. The opportunity to make presentations at national and international conferences in pediatric plastic craniofacial are offered to fellows who have appropriate material.

Fellows will take in house night call on a rotating schedule with the other pediatric plastic surgery fellows and plastic surgery residents from UT Southwestern Medical School. The average number of on-call hours during a seven-day period is 12 to 24 hours, one day per week and one weekend per month. On-call responsibilities include providing weekday and weekend coverage for the emergency room areas.

Faculty

Listed below are the faculty members involved in the supervision of the pediatric plastic craniofacial fellows at Children's Medical Center. The program has nine full time pediatric plastic surgeons that are board certified and have extensive experience in plastic surgery and pediatric plastic craniofacial surgery, and hold a current Texas Medical License. These physicians include:

• H. Steve Byrd, M.D.
• P. Craig Hobar, M.D.
• A. Jay Burns, M.D.
• Richard Ha, M.D.
• John Burns, M.D.
• Sean Bidic, M.D.
• Michel Saint-Cyr, M.D.
• Jonathan Cheng, M.D.
• Andrew Trussler, M.D.
• Ronald Hoxworth, M.D.

Supervision

Fellows are continuously under close supervision of attending pediatric craniofacial surgeons and plastic surgeons in the performance and interpretation of various pediatric craniofacial procedures. Their performance in the clinical arena and their ability to construct and carry out a management plan is reviewed on a case-by-case basis throughout the day. In the pediatric plastic surgery department, fellows are closely supervised and their skills are continuously evaluated.

Evaluation

The fellows will also work side by side with residents in plastic surgery residency and other pediatric plastic surgery programs from UT Southwestern Medical School. They will be under the direct supervision of the Pediatric Plastic Craniofacial Surgery Program Director, Dr. Craig Hobar and the Pediatric Plastic Surgery Chief of Service, Dr. H. Steve Bryd. Faculty members will also provide daily feedback to ensure continual growth by each fellow during the program. Fellows are evaluated by the program director semi-annually. Written evaluations from each faculty member are reviewed with the fellow at that time. Fellows are required to evaluate the faculty, rotations and fellowship program annually.

Eligibility and Application Process

Applicants must demonstrate that they have completed an appropriate level of training for them to participate in the care of pediatric craniofacial surgery patients. This can be accomplished by the successful completion of three to five years of general surgery training and two to five years plastic surgery training at UT Southwestern or at another institution. The fellowship is for one year (12 months) in duration. There is no board certification process in pediatric craniofacial surgery, so fellows completing the program at UT Southwestern / Children's Medical Center do not receive additional formal certification.

International applicants must meet the requirements established by the Texas Medical Board and the U.S. Immigration Services. Applicants from the United States should have completed a prescribed course in plastic surgery at an approved accredited residency and be board-eligible or certified in the specialty of plastic surgery.

Potential applicants should inquire as to the availability of a training position that will begin when the applicant desires. Positions usually begin on July 1st, and are twelve (12) months in duration. Interested applicants should contact the program director and submit a personal statement, curriculum vitae, three letters of recommendation from faculty members, and verification of past training and examination scores. Interview dates depend upon the availability of an opening in the fellowship-training program.

The fellowship participates in the Craniofacial Fellow Matching Program which is sponsored by the Association of Academic Chairmen of Plastic Surgery and administered by August Colenbrander, M.D. in San Francisco, California.

The selection of applicants outside the match is at the discretion of the Program Director, based on whether the candidates satisfy requirements of UT Southwestern Medical School. Decisions are based on demonstrated commitment to the field of pediatric plastic surgery. Applicants who are considered competitive for appointment are normally offered a position with a start date of July 1.

Upon selection into the program all applicants must meet the requirements established by the Graduate Medical Education Office at Children's, as set by the Texas Medical Board, Educational Commission for Foreign Medical Graduates (ECFMG) and the Immigration Services. UT Southwestern and Children's Medical Center of Dallas require international graduates to meet the terms for an Institutional Permit, as outlined by the Texas Medical Board and have the documents necessary for a J-1.

This program does not provide the necessary elements to qualify to take the special examination for the certificate of competency. However, the Children's Graduate Medical Education Office, in conjunction with the Department of Plastic Surgery at UT Southwestern, does provide a certificate indicating the candidate has satisfactorily completed applicable years of fellowship with the Pediatric Plastic Craniofacial Surgery Fellowship Program.

Application

Listed below is the application for the Plastic Craniofacial Surgery Fellowship, to be printed and filled out. Please mail the application and applicable documents to our Fellowship Coordinator:

Kaydance Hope
1801 Inwood Rd. WA4.224
Dallas, TX 75390-9132

Craniofacial Surgery Fellowship Application (PDF)