Abstract book - ESPRAS

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.