Craniofacial surgery is designed to correct genetic conditions and deformities of the face and skull. Trauma, tumours and complications of infections can also cause craniofacial deformities. Craniofacial operations are in the majority of cases, multi-disciplinary surgeries. Most craniofacial surgeries like craniosynostosis repair are major procedures involving a team approach. Typically a craniofacial team consists of a plastic surgeons and neurosurgeon specializing in craniofacial surgery, and anesthetists experienced in pediatric anesthesia. Our surgeries are performed in a private hospital facility. Failing to treat or delay of treatment of craniofacial defects can in some instances lead to serious functional and cosmetic problems. Functional problems can occur due to increased intracranial pressure and through insufficient facial growth leading to obstruction of 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 development of the child and hinder their social development and adjustment.
The effect of suture synostosis depends on the specific suture involved and can lead to scaphocephaly if the sagittal suture is fused, plagiocephaly if one of the coronal or lambdoid sutures is involved and brachycephaly if both coronal sutures are closed. Premature metopic synostosis can lead to trigonocephaly and multiple suture synostosis or pansynostosis can lead to even more severe deformities. Some of the craniosynostosis syndromes like Apert, Crouzon or Pfeiffer syndrome have multiple suture synostosis plus additional growth disturbances in the base of the skull and this can lead to midface hypoplasia and exorbitism.
Operations to treat 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 are limited to very mild deformities or if children are operated on very early.
More conservative treatment approaches, through use of “head bandaging”, or “head positioning” with special helmets, are reserved for deformational defects unrelated to cranial suture pathology. Positioning the child and craniosacral therapy have been shown beneficial in these cases.
With severe facial deformities with midface hypoplasia 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’. By repositioning the facial bones, an improvement in function and appearance can be achieved. We have 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.
Hypertelorism is a severe craniofacial abnormality associated with facial clefts. Treatment is from age 4 years by surgically releasing the orbital segments and repositioning them as needed.
Other craniofacial conditions
A lot of other conditions exist with craniofacial problems and facial asymmetries that we evaluate and manage on a regular basis:
- Treacher Collins syndrome
- Goldenhar syndrome
- Parry Romberg hemifacial atrophy