Craniofacial Reconstruction
Also known as head and face reconstruction, craniofacial reconstruction treats distortions in the head and face. Depending on the severity of your case and the actual irregularities you have, craniofacial reconstruction will vary from person to person.
Surgery involves the brain, eyes, facial skin and bones, skull and nerves. Therefore, a plastic surgeon and a neurosurgeon are required to perform the surgery more often than not.
While the client is under general anesthesia, the surgery can be completed anywhere between four and 12 hours.
About the Procedure
In craniofacial reconstructions, some of your facial bones are cut and placed into a more natural facial structure. To do this, bone may be taken from other areas of your body such as your ribs or skull in order to replace the bones in the head and face that have been moved.
Sometimes, surgery may cause your face, neck or mouth to swell, blocking your airway. In these instances, a tiny hole is inserted in the neck and a tube is then placed in your airway.
The tube enables you to breathe should you experience swelling in your face, affecting your airway post-surgery.
Why Head and Face Reconstruction?
Why even have this procedure performed? The need for craniofacial reconstruction depends on several factors. Among them are:
1) Head, face and jaw injuries
2) Birth defects such as Apert’s syndrome
3) Tumors. Treatment of tumors can also result in head and face deformities.
Children and Craniofacial Reconstruction
Children get head and face reconstruction to mend the irregularities they have in the shape of their skull. They also undergo craniofacial reconstruction to restore deformities in the head and face caused by genetic defects or traumatic injuries such as child abuse.
In children, surgeons must use special techniques because the child will continue to develop his or her facial bones and skull.
Adults and Craniofacial Reconstruction
Most craniofacial reconstruction in adults is performed after trauma to the face or head. Craniofacial reconstruction is also used for cancer patients who need to restore their bones and tissues that may have been affected after tumor surgery. Head and face reconstruction is also used to enhance the physical appearance of the person’s mouth, face and head.
Craniofacial reconstruction can be used in forensic medicine, as a way to help identify a dead person and the cause of death.
Birth Defects
According to the American Society of Plastic Surgeons, about 7 percent of children born each year in the U.S. possess birth defects in their head and face.
The most common birth defects and genetic disorders that require head and face reconstruction are:
1) Treacher Collins Syndrome—when the human chromosome 5 mutates, it generates Treacher Collins Syndrome. This condition results in craniofacial deformities such as an excessively small jaw and airway. In some cases, the ears may be abnormal or even missing.
2) Cleft Palate—as the fourth most common birth defect in American children, a cleft palate affects about one in every 700 infants.
3) Down Syndrome—this is the most common congenital disorder resulting in profound facial features such as small ears, slanted eyes and a large tongue. In the U.S., there are about 350,000 people living with Down syndrome.
4) Crouzon and Apert Syndromes—these syndromes are usually classified together as they consist of a closing in the bones at the top of the skull. As a result, people with these syndromes have a deformed head shape and breathing problems.
Craniofacial Reconstruction of Birth Defects
In children with birth defects, head and face reconstruction requires several specialists, a surgeon and the child’s parents to communicate with each other. Proper diagnosis of the actual birth defect must precede anything else. After diagnosis, a customized treatment plan is devised consisting of the surgery needed as well as post-surgery care.
Surgeons must consider the continual growth in a child so craniofacial reconstruction must allow for that growth in the child’s head and face.
General anesthesia is always used in children undergoing head and face reconstruction, requiring about three to six hours to complete.
Craniofacial Reconstruction after Surgery or Trauma
Head and neck reconstruction after surgery or trauma differs from person to person. In order to assess injuries to the head and face, emergency workers must clear the person’s airway. Clearing the airway allows emergency workers to treat facial injuries.
Most patients with facial trauma also have injuries in the head, abdomen or chest which requires focus on the brain and spinal column.
Before getting x-rays or CT scans, your doctor will locate where the bone fracture is and the severity of it. After assessment, x-rays or CT scans are taken of the face injuries which further assist the doctor in examining the fractures.
Surgery after trauma in the face may require up to 14 hours since your doctor will want to fix as much as he or she can in a single treatment. Surgery may involve taking bone from other areas in your body to fix deformed facial bones, or using polymer implants to fill in minor areas with missing bone.
If you have broken facial bones, your surgeon will hold them together using titanium mini-plates, a technique called rigid fixation.
Cancers of the head or neck may need bone grafts after removal of the tumor. After cancer treatment, your surgeon may use special tools to remerge your nerve fibers and facial blood vessels.
Diagnosis
Diagnosis of head and face reconstruction depends on the defect at hand and how the defect was caused. Some genetic disorders that are linked with birth defects such as Down syndrome can be revealed before birth.
To examine the patient’s deformations, x-rays, CT scans, imaging studies and magnetic resonance (MRI) are used in order to formulate the surgery plan.
Cancer Cases
Each year, about 55,000 Americans are diagnosed with head and neck cancers. These cancers can affect the larynx, the mouth and nasal passages. Fortunately, most of these cancers can be prevented as they are derived from too much sun exposure or tobacco.
Signs and Symptoms of Head and Neck Cancer
1) Voice change—cancers in the larynx often cause changes in the voice. If you notice a change in your voice that persists for longer than two weeks, consult with your physician as soon as possible. A head and neck specialist is called an otolaryngologist.
2) Swollen mouth—cancers in the mouth or tongue often cause tenderness or swelling that persist and eventually become infected. If you notice swelling that is accompanied by lumps in your neck, see your doctor or dentist right away as they can determine of a biopsy is mandatory. After a biopsy, you can then be referred to a head and neck surgeon—an otolaryngologist.
3) Lump in your neck—cancers in the head or neck most often spread to the lymph nodes in the neck before eventually spreading to other areas of your body. If you notice a lump in your neck—especially one that has been there longer than two weeks—see your physician as soon as possible.
Skin changes—as the most common head and neck cancer, basal cell cancer of the skin is a minor problem if detected and treated early. Basal cell cancers are usually on the most exposed areas like the face and ears.
Traumatic Injuries to the Face and Head
Traumatic injuries to the face and head can be comprised of heat, chemicals, and tears. Repairing burns requires plastic surgery while most traumas require maxillofacial surgery.
Children mostly experience facial traumas due to accidents or animal bites.
Post-surgery
Adults who undergo head and face reconstructive surgery will most likely be monitored in the hospital for one to two days as airway problems are common. Depending on the severity of your case, you may need to stay in the intensive care a bit longer. After-care treatment could range from antibiotics to breathing exercises.
Children who have had craniofacial reconstructive surgery will most likely stay in the intensive care unit for about two days and in the hospital for four to five days.
Children are also advised to refrain from swimming for two months post-surgery and from sports for about six months after reconstructive surgery.
What are the Risks?
The risks involved in craniofacial reconstructions are breathing problems, bleeding, infection and reactions to anesthetics. Some risks affect the results of head and neck reconstructions such as:
1) Smoking
2) HIV infection
3) Poor nutritional habits
4) A weak immune system
5) Tissue disease such as lupus
6) Poor blood circulation
7) Nerve damage
8) Scarring
Results
Craniofacial reconstruction results vary from case to case. However, good results consist of an enhanced head and face shape. This includes a more aesthetically pleasing appearance in the nose, mouth, teeth, eyes and ears.
Craniofacial reconstructive surgery is a rather complex procedure that concentrates on the eyes, spinal cord, brain and other sensory organs.
