Craniofacial deformities, or alterations in the natural form of the face or skull, can be congenital or acquired. For those patients born with craniofacial anomalies, the obstetrician or pediatrician is the initial point of contact for appropriate medical treatment. Accurate diagnosis at an early age not only avoids unnecessary emotional distress for the parents and family, but it also minimizes potential future problems associated with the deformities by early correction. For those patients with acquired deformities as the result of trauma or tumor resection, referral to a craniofacial center may be desirable to help restore facial function and appearance.
When Craniofacial Surgery is recommended as treatment for a specific anomaly, there are two distinct goals of this surgery. First, is the attempt to restore the patient to as near normal function as possible and to prevent future dysfunction. Secondly, surgery may be necessary to correct structural disfigurement in order to achieve optimal appearance. A patient suffering from a facial deformity may experience problems in dealing with his disfigurement emotionally or socially. Often, improvements in appearance following craniofacial surgery can lead to increases in self-esteem, self-confidence and social acceptance. The psychological benefit of craniofacial surgery is an extremely important goal of the surgery.
A number of advances have been made in surgical technique and technology as applied to craniofacial surgery. Calvarial bone grafts for the most part have replaced rib and hip grafts. These outer table split grafts are available in an assortment of sizes and shapes with less painful donor sites and less resorption compared to rib or hip bone.
Tremendous radiological advances have been made in the past ten years that have improved preoperative analysis of craniofacial deformities. The use of two- and three-dimensional CT scans has drastically enhanced our ability to analyze these complex deformities. Computer analysis of photographs and radiographs is also available and can provide further information for preoperative planning.
Another major advancement has been the application of rigid skeletal fixation to craniofacial surgery. The new techniques of rigid skeletal fixation combined with wide exposure have allowed the craniofacial surgeon to obtain much better stability and eliminate intermaxillary fixation in most cases. This technique offers significant advantages, particularly in children. It has improved our overall quality of results as well as decreasing morbidity.
Treatment of craniofacial problems does not end with surgical restoration, but continues for many years. This follow-up should be conducted by the craniofacial team in order to maintain a continuity of care that assures the patient the best long term outcome. As a child grows and develops, asymmetries may result if areas of the face fail to develop equally; therefore, a child's growth and development must be routinely followed. Sometimes it may be necessary to repair these asymmetries surgically. Often, major craniofacial deformities require multiple, staged procedures performed at different ages. Once treatment is initiated, it is important that follow-up care continues.