Craniofacial Surgery

Craniofacial surgery is a specialized type of plastic surgery that deals with the correction and reconstruction of facial and skull bone deformities. It involves the treatment of congenital anomalies such as cleft lip and palate, craniosynostosis (premature fusion of skull bones), as well as acquired deformities resulting from trauma or disease. 

Definition and Overview

Craniofacial surgery is a specialized field of surgery that addresses both congenital and acquired abnormalities of the head, neck, face, skull, jaws and related structures. While bone manipulation is often a key component of this type of surgery, it is not limited to any particular type of tissue. Craniofacial surgeons are skilled in treating a range of anatomical features including skin, nerves, muscles, teeth, and other associated structures.(1)

Types

Craniofacial surgery addresses both congenital and acquired deformities and involves the treatment of various types of tissues, including bone, skin, nerve, muscle, teeth, and related anatomy. The surgery is not limited to specific tissues. Examples of craniofacial surgeries include:

• cleft lip and palate repair, 
• craniosynostosis correction, 
• midface augmentation or repositioning, 
• distraction osteogenesis, 
• hemifacial microsomia correction, 
• treatment of vascular malformations and hemangiomas, 
• and management of deformational or positional plagiocephaly.(2)

Candidates

The eligibility for craniofacial surgery may vary depending on the specific condition and the individual's overall health and medical history. A qualified craniofacial surgeon can evaluate the patient's condition and determine whether they are a suitable candidate for surgery.

Craniofacial surgery is typically performed on individuals who have congenital or acquired deformities affecting 

• the skull, 
• face, 
• or associated structures. 

This can include infants, children, and adults with conditions such as cleft lip and palate, craniosynostosis, hemifacial microsomia, vascular malformations, and facial trauma. A consultation with a craniofacial surgeon is necessary to determine if a person is a good candidate for this type of surgery.(3)

Risks and Side Effects

As with any surgical procedure, craniofacial surgery carries some risks and potential side effects. Some of the common risks and side effects of craniofacial surgery may include:

• Infection
• Bleeding, including hematoma
• Increased air around the brain (Pneumocephalus) 
• Cerebrospinal fluid leak
• Imbalance of water and sodium metabolism (Diabetes insipidus)
• Loss of smell
• Facial nerve injury
• Chronic tearing problems
• Vision changes
• Facial numbness
• Mucus retention

In some cases, patients may also experience complications such as 

• Hematoma (a collection of blood under the skin),
• Nerve damage, 
• Fluid accumulation, 
• Adverse reactions to anesthesia or medication.

In addition to these risks, craniofacial surgery may also involve certain long-term effects, such as changes in facial symmetry, altered sensation or movement, and the need for additional surgeries or follow-up treatments.(4,5)

Post-Procedure and Follow-up

After craniofacial surgery, the patient will be admitted to the hospital's intensive care unit for at least two days. If there are no complications, the patient will be transferred to a regular hospital room for up to a week of close monitoring. During this time, the doctor will conduct follow-up sessions in the hospital to check for signs of infection or other complications. Pain medication, changes to surgical dressings, and antibiotics may be used to prevent infection. Patients who have had surgery on the jaw or mouth may be put on soft diets.

Once the patient is discharged, they will need to have regular follow-up appointments with their doctor to monitor healing, detect any complications, and assess recovery progress. Patients who have developed deformities as a result of the surgery may need reconstructive surgery, which can take years depending on their age, health, and other factors. They may also need to see an oral or plastic surgeon, and those experiencing emotional trauma may be referred to a psychologist or support group.

During the first two months after surgery, follow-up consultations will be frequent, with appointments scheduled just a week apart if necessary. As recovery progresses, appointments may be spaced out to every 2-3 months during the first year, and then once or twice a year for up to five years. The doctor may perform imaging scans from time to time to check the structure of the operated area and surrounding tissues. (6)

Recovery 

The recovery process for craniofacial surgery can vary depending on the specific procedure performed and the individual patient. However, in general, recovery from craniofacial surgery is a gradual process that may take several weeks or even months.

Immediately after the surgery, the patient may experience swelling, bruising, and discomfort around the surgical site. Pain medication may be prescribed to manage any pain, and the patient may need to stay in the hospital for a few days or more, depending on the extent of the surgery.

During the first few weeks of recovery, the patient will need to rest and avoid strenuous activity. They may also need to avoid bending over or lifting heavy objects, as this can increase pressure on the head and affect the healing process.

In addition to rest, the patient may need to follow specific care instructions, such as keeping the surgical area clean and dry, taking antibiotics as prescribed, and avoiding certain foods or drinks.

Over time, the patient will gradually start to feel better and may be able to return to their normal activities. However, it may take several months for the full effects of the surgery to be realized, and the patient may need to attend follow-up appointments with their surgeon to monitor their progress. (7,8)

Results

Craniofacial surgery is performed with the cooperation of more than one surgeon with different specialties to obtain the desired result. These include plastic and reconstructive surgeons and may also include neurosurgeons, ophthalmic (eye) and oculoplastic (eye socket and related structures) surgeons, oral and maxillofacial (jaw and facial) surgeons, and otolaryngology (head and neck) surgeons.

Craniofacial surgery results in repaired bone and tissue damage and improved appearance of deformed face and head areas. For children with craniofacial abnormalities, performing surgery early can reduce the negative effects of such conditions on growth, development, and functional abilities. (9)