Craniofacial reconstruction - series

Normal anatomy

There are four major bones of the face: the maxilla, the zygoma, the mandible, and the frontal bone of the cranium.

Indications

Patients requiring craniofacial reconstruction have:

• birth defects (such as hypertelorism, Crouzon's disease, Apert's syndrome)
• injuries to the head, face, or jaws (maxillofacial)
• tumors
• deformities caused by treatments of tumors

Procedure

While the patient is deep asleep and pain-free (under general anesthesia) some of the facial bones are cut and repositioned into a more normal facial structure. The procedure may take from four to 14 hours to complete. Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in the spaces where bones of the face and head have been moved. Small metal screws and plates are sometimes be used to hold the bones in place and the jaw may be wired together to hold the new bone positions in place. If the surgery is expected to cause significant swelling of the face, mouth, or neck, the patient's airway may be an area of major concern. The airway tube (endotracheal tube) normally used for long surgical procedures under general anesthesia may be replaced with an opening and tube directly into the airway (trachea) in the neck (tracheotomy).

Aftercare

Depending on the extent of surgery and how the patient is breathing, the first two days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave the hospital within one week. Complete healing may take up to six weeks.