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CRANIOFACIAL SURGERY

Craniofacial Surgery

Craniofacial surgery is designed to correct genetic conditions or deformations in the facial and skull areas. Trauma, tumours and complications of infections can also cause craniofacial deformities.

Congenital craniofacial defects which can be treated surgically include:

  • craniosynostosis (premature closure of the cranial sutures)
  • craniofacial syndromes (e.g. Apert-syndrome or Crouzon-syndrome)
  • lip, jaw and palate malformation and harelip
  • facial asymmetry
  • encephaloceles
  • facial clefts and naso-frontal dysplasia (described by Tessier)

Craniofacial defects that are not congenital could be caused by:

  • injuries to the face
  • tumours
  • infection

Craniofacial operations are, in the majority of cases, multi-disciplinary surgeries. Most surgeries like craniosynostosis repair and operations including the face and cranium are done by a team of plastic surgeons specializing in craniofacial surgery, a pediatric neurosurgeon and an anesthetist experienced in pediatric anesthesia. Frank works with an experienced craniofacial team. Failing to treat or delay of treatment of craniofacial defects can lead to serious functional and cosmetic problems. Functional problems can occur due to increased intracranial pressure and through pathological cranial and facial growth obstructing the child’s airway (midface hypoplasia) or exposing the orbits and eyes (exorbitism). In the case of a child, a disfiguring defect can negatively affect the psychological and social development of the child and hinder their social development and adjustment.

Operations to treat the premature closure of cranial sutures involves a procedure known as frontal-orbital advancement and depending on the extent of the lesion, partial or total cranial decompression with cranial vault remodelling.

Strip craniectomies have been found less efficient in the treatment of craniofacial disorders and have shown less favourable long-term results with a high recurrence rate.

More conservative treatment approaches, through use of “head bandaging”, or “head positioning” with special helmets, is reserved for deformational defects unrelated to cranial suture pathology. Positioning the child differently and craniosacral therapy have been shown beneficial in these cases.

 

With severe facial deformities, the principle of distraction is applied after a repositioning osteotomy of the facial skeletal structure is accomplished. Distraction is the process of slowly shifting the mid-face over a period of time using ‘distractors’ Through a repositioning of the facial bones, an improvement in function and appearance can be achieved.

 

Frank has developed a new and less invasive technique of midface distraction without osteotomies in young infants. This method has been shown effective with good outcomes in children under the age of 2 years.

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