Definition and Overview

Craniofacial surgery is a surgical specialty of oral, maxillofacial and plastic surgery that focuses on correcting congenital or acquired malformations, traumatic deformities and disfigurements of the jaw, head, neck, face, skull and other associated features. Due to the various body parts involved in the operation, a patient’s team of surgeons is typically composed of a neurosurgeon (brain and nerves), plastic surgeon (for skin and face) and head and neck surgeon.

Craniofacial surgery is often a delicate, complicated surgical procedure that requires ample preparation. Anyone who is about to undergo this operation is required to consult a team of surgeons weeks before the surgery to prepare the patient’s body, to provide detailed information about the procedure particularly its possible outcome, risks and benefits as well as the techniques and the type of anaesthesia to be used, among others. This consultation, which is the first in a long series of steps that must be taken before the actual surgery, provides the patient or in case of minors, the parents or guardians, an opportunity to ask questions or raise concerns to better understand the procedure and how they can help so that associated risks and complications can be minimised or avoided.

Who Should Undergo and Expected Results

Craniofacial surgery consultation is for both children and adults who have congenital malformations, disfigurements in the head area (such as those caused by cancer treatment) and traumatic deformities. In cases where the patient is a child or a minor, the consultation must be attended by at least one of the parents or guardians.

Some of the conditions where craniofacial surgery is the recommended treatment include the following:

  • Craniosynostosis – The bones of an infant’s skull are joined together by cranial sutures, a process that begins when the child is about six months old and completed until well into adulthood. Craniosynostosis is the result when this process takes place prematurely in-utero. This condition is associated with functional problems, developmental delay and visual impairment.
  • Cleft lip and palate – These are congenital conditions that develop during the early stages of pregnancy. While cleft lip develops due to an inadequate amount of tissue in the lip or mouth area, a cleft palate is a split in the roof of the mouth.
  • Microtia – This is a congenital deformity of the external ear characterised by underdeveloped pinna.
  • Other craniofacial syndromes such as Goldenhar, Velocardiofacial and Treacher-Collins syndromes
  • Severe ear deformities

How Does the Procedure Work

Craniofacial surgery consultation is scheduled when the patient’s primary healthcare provider has concluded that surgical procedure is the only possible treatment option for the patient, who are usually children. The patient, along with the parents, will then be referred to a craniofacial surgeon.

As mentioned above, this type of surgery requires weeks of preparation to ascertain the success of the operation and patient safety. During the initial consultation, the surgeon will conduct an interview to understand the patient’s medical and family history, perform a thorough physical examination and conduct tests and procedures, including:

  • CT and MRI scans – These are used to scan the brain and skull to confirm the presence of any abnormalities. In very young children, these scans are conducted under general anaesthesia as it is crucial that they stay very still during the procedure. Any movement can affect the result of the scans.
  • Genetic testing – If the surgeon suspects that the abnormality is caused by an underlying genetic defect or hereditary syndrome, genetic testing will be conducted. This type of test requires a blood sample that is sent to a laboratory for analysis.
  • Blood test – Patients who undergo craniofacial surgery may require a blood transfusion during the operation. Blood test is thus performed to determine the patient’s blood type so matching blood, either from a blood bank or donors can be prepared before the procedure.

    Once all the tests have been performed, the surgeon along with a multidisciplinary team of medical professionals who can include an ENT, plastic and oral and maxillofacial surgeons, will formulate the best surgical plan, taking into consideration the patient’s condition and his unique circumstances.

The surgeon may also make a referral to other specialists such as an ophthalmologist depending on the initial diagnosis. In certain cases, patients with skull deformities experience increased pressure inside their brain that affects the development of the eyes. Such must be assessed before any surgical procedure can be performed so possible risks and complications can be identified and minimised.

During the consultation, the patients or their parents will also be informed about the specifics of the procedure. They will be informed that general anaesthesia will be used (as such, a consultation with an anaesthesiologist is also crucial), that the surgery can last at least eight hours and that the patient will be required to stay in the hospital for at least three days.

Weeks before the surgery, the surgeon may prescribe therapies and supplements to increase the patient’s red blood cells so the need for blood transfusions during surgery can be minimised and also ascertain that the patient will heal and recover as soon as possible.

Possible Complications and Risks

Just like any other surgical procedure, craniofacial surgery is associated with a number of risks and complications, including:

  • Blood loss
  • Infection
  • Blood clotting problems
  • Breathing problems
  • Nerve or brain damage
  • Bone grafts loss (partial or total)
  • Permanent scarring

    References:

  • Baker SR. Reconstruction of facial defects. In: Flint PW, Haughey BH, Lund V, et al., eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 24.

  • McGrath MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

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