Craniofacial Surgery

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Craniofacial Surgery
Craniofacial Surgery began with the pioneering work of Paul Tessier in France in the late 1960s on patients with gross congenital deformities of the craniofacial region. Since that time a number of units have been developed around the world to cope with these problems and a considerable experience has been accumulated by these units over the following two and a half decades not just in congenital deformities, but other problems as well.

Scope of Craniofacial Surgery
The craniofacial region encompasses the base of the skull, the facial skeleton and underlying soft tissues and the skull vaults and scalp. The orbits, interorbital area, nose and skull base are key areas in the craniofacial region anatomically.

The scope of craniofacial surgery includes congenital craniofacial deformities, tumours affecting the craniofacial region, in particular the skull base, and trauma in this anatomical region whether it be acute trauma or post-traumatic deformity. Tumours of the craniofacial region can be benign or malignant and the congenital deformities that affect this region are mainly the craniosynostoses and the craniofacial synostosis syndromes such as Apertís and Crouzonís syndromes, craniofacial clefts (other than cleft lip and palate), meningoceles and encephaloceles in the craniofacial region, and a collection of congenital problems which affect the craniofacial region such as hemifacial microsomia, other causes of facial asymmetry and Treacher-Collins syndrome.

Assessment and Treatment
Craniofacial problems usually need to be assessed by a multidisciplinary team in a craniofacial clinic environment where appropriate experienced specialists can give their opinions and plan management. These will include a craniofacial reconstructive surgeon, and often a neurosurgeon, ophthalmologist, otolaryngologist, paediatrician, anaesthetist, or others and varying combinations of these specialties as appropriate. Medical genetics opinion may be required for the diagnosis of congenital deformities and modern radiological imaging techniques are essential in the vast majority.

After appropriate assessment, surgical treatment may be recommended and this will vary considerably depending on what the particular problem is. Usually craniofacial surgery for deformity can be carried out without making visible scars on the face although the resection of some tumours which involve the surface soft tissues may result in visible scarring post-operatively. The surgery for some craniofacial conditions is major with some degree of risk which again will vary with the particular problem being dealt with. Sometimes bone grafts need to be harvested from other areas of the body such as the ribs. Major craniofacial operative procedures need to be carried out in a hospital environment which offers appropriate facilities and staff who are experienced in looking after these patients.

The results of craniofacial operations can vary with the condition being dealt with. Boney abnormalities can be more easily corrected than soft tissue ones and the proportion of bone and soft tissue components in the deformity will often determine the final cosmetic result that can be obtained. The most difficult problems in craniofacial surgery are some of the craniofacial synostosis syndromes, neurofibromatosis, and some of the malignant tumours affecting the skull base. While surgery can be very helpful in these patients there is frequently some residual deformity after treatment and the complication rate following surgery in these particular groups is higher than in others.