Definition and Overview

Craniofacial surgery is an invasive surgical procedure performed to correct birth defects or acquired malformations, traumatic deformities and disfigurements of the face and skull, the most common of which are cleft lip and palate that affect thousands of infants worldwide.

Anyone who has undergone any type of craniofacial surgery is scheduled for a series of follow-up that can span up to five years. The goal is to ensure the efficacy of the surgical treatment, monitor the development of complications so they can be addressed in a timely manner and provide a list of medications and activities that the patient must avoid, among others. During the follow-up, the doctor will also assess the emotional effects of the surgical procedure to the patient and if needed, a referral to a mental health professional will be made.

Who Should Undergo and Expected Results

A series of follow-up consultations is required for all patients who have undergone any type of craniofacial surgery. Since this surgical procedure often involves very young children, including infants, consultations are typically a discussion between the surgical team and the patient’s parents or guardians.

The expected results are:

  • Ensuring that the surgical procedure has adequately corrected the patient’s condition
  • Making sure that the risks of complications are identified and that measures are taken to prevent or minimise their impact on patient’s recovery
  • Identifying patient’s needs following the procedure such as medications and therapies

How Does the Procedure Work

Following craniofacial surgery, the patient remains in the hospital’s intensive care unit for a minimum of two days. If no complications have been noted, the patient will be transferred to a regular hospital room and may be required to stay in the hospital for up to one week for close monitoring. As such, the first couple of follow-up sessions are conducted in the hospital during which, the doctor will check for signs of infections and other complications. Short-term aftercare will include the use of pain medications, changes of surgical dressing and antibiotics to minimise the possibility of infection. Patients who have undergone the procedure to correct deformities that involve the jaw or mouth will be placed on soft diets.

Once the patient has been discharged from the hospital, he will be required to make regular follow-ups with his doctor. The goal is to ensure that the wound is healing properly, that no complications have developed and that the patient’s recovery progress is what is expected.

In cases wherein the initial surgery has caused deformity (such as in the case of surgical cancer treatment), the patient will be scheduled for a reconstructive surgical procedure but this could take years depending on the patient’s age, general health condition, the preference of his parents, underlying conditions and other factors. The patient may also need to make follow-up visits to an oral or plastic surgeon depending on the part of the head that was operated on. Older patients who are suffering from emotional trauma due to their appearance may be referred to a psychologist or support group.

The frequency of follow-up consultations is expected to be often during the first two months. Depending on the prognosis or how the patient is recovering, follow-ups may be spaced just a week apart. If recovery is progressing as expected, the follow-ups will be scheduled every 2-3 months during the first year and then once or twice a year for up to five years.

From time to time, the doctor will perform exams particularly imaging scans to check the structure in the operated area and the tissues that surround it.

Possible Complications and Risks

Craniofacial surgery follow-up is a crucial part of the patient’s treatment plan. That is why, it is discussed and agreed to by patients (and their parents) even before the surgical procedure is initiated. Although the surgery is linked to several risk and complications (some of which are life-threatening), follow-up consultations come with minimal to zero risk particularly if no tests are conducted. However, in some instances, CT and MRI scans may be performed to check on the structures that were operated on. Exposure to radiation during the scan has been linked to the development of cancer later on in life although the chances are very slim.

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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