REKLAMA FOTONA
L1. Craniofacial deformity Prof. Ian T. Jackson Institute for Craniofacial and Reconstructive Surgery Southfield, USA Craniofacial deformity can be relatively minor or it can be devastating. It can be congenital or it may result from trauma or tumor. Craniosynostosis A single suture involvement can be treated at any time; multiple suture involvement is associated with raised intracranial pressure and suture release with skull fragment repositioning should be performed. Any suture may be affected. Measurement of head size is important in decision- making. Postural skull deformity should be diagnosed correctly, and in most cases surgical treatment is not required. Molding helmets are employed if the deformity does not self-correct. Crouzon and Apert Syndromes Rarely is early treatment necessary, but with the advent of distraction osteogenesis there is a move towards earlier correction. The long-term follow-up of this treatment is not, as yet, available - it may only be an Aevent in time@ and further distractions may be necessary. The surgical management consists of frontosupraorbital advancement as required, with midface an advancement at the LeFort III level. Hypertelorism The basic mechanism is that of a midline cleft and the severity is variable. Severe cases require early treatment to bring the orbits into their correct position and hopefully establish binocular vision. Secondary procedures are frequent, e.g. further osteotomies, nasal reconstruction, and palatal procedures. Facial bipartition is frequently indicated, this gives very stable and satisfactory correction. If there is a frontal encephalocele, this is resected and repaired at the same time as the bony correction. Hypotelorism This is a rare condition, however if it occurs orbital osteotomies are performed. The orbits are moved laterally and the midline defect is bone grafted. Hemifacial Microsomia This occurs with varying severity, in the most severe cases all levels of the face are involved - skull, orbit, maxilla, mandible and soft tissue. The bony problems are dealt with by osteotomies and/or bone grafts. The soft tissue is augmented with free tissue transfer. Distraction osteogenesis will be used when indicated. Facial Clefts These can involve specific cases or multiple facial regions. The minor clefts are treated in a relatively standard fashion by excision, local flaps, and suture, the more severe cases may need the addition of bone grafts, osteotomies or free tissue transfers, as indicated. Team Approach in Craniofacial Surgery These complex anomalies require a multi-specialist approach with an experienced and dedicated team - a plastic surgeon experienced in the craniofacial area, neurosurgeon, maxillofacial surgeon, orthodontist, prosthedontist, pediatrician, social worker, experienced nursing staff, and a good anesthetic team.
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