Craniofacial Surgery

• Improvement or restoration of function
• Improvement or restoration of structure and appearance
• Increase in self-esteem, self-confidence, and social acceptance.

Craniofacial problems are usually assessed by a multidisciplinary team in a craniofacial clinic environment where appropriate experienced specialists can give their opinions and plan management. During the diagnostic evaluation (which takes about one and one half day), patients and their families have a series of appointments with professionals in any the following fields:

• adult general or pediatric dentistry
• audiology
• genetics
• otolaryngology
• oral and maxillofacial surgery
• orthodontics
• pediatrics
• facial surgery
• prosthodontics
• psychology
• social work
• speech-language pathology
• other specialties as needed

Team members meet to discuss their findings and recommendations. An integrated treatment plan is developed, and a designated team professional meets with the family to review the patient's needs and formulate a treatment approach.

During this consultation, the patient and the team representative will discuss the changes that the patient will experience. He/she will explain the particular procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia required, surgical facility, and costs.

The team will require a complete medical history. They may also give you specific instructions preparing for surgery, including guidelines for eating and drinking, smoking, and taking or avoiding vitamins, supplements and medications. There may also be other preparations necessary prior to surgery, such as orthodontic work, or the wearing of a particular training appliance.

The patient and his/her family should take this opportunity to ask all the questions they have about the surgery. They should ask for, and follow up on, patient references. Learning everything possible about options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.

The length of time required for a given procedure should be discussed with your team representative; the following are examples and are approximate:

• Cleft lip repair: 2-3 hours.
• Cleft palate repair: 2 hours
• Ear reconstruction: 3-4 procedures of varying lengths.

Craniofacial surgery involves major reconstruction of bony or cartilaginous tissue. Because the affected part of the head may surround the eyes, ears, mouth and/or nose, special care will have to be taken to protect these areas. Speaking and chewing may be hampered, and in some cases will be prevented altogether, requiring feeding through a tube. Infant patients undergoing cleft surgery will need to be fed with a special syringe feeder with a soft tube. After 3 weeks, your doctor may discontinue some of these precautions.

Recovery from some procedures, such as upper jaw surgery, can take up to six months, as the reset bone fragments slowly fuse back together. Discoloration and scarring will fade and improve in appearance in six to twelve months.

The most difficult problems in craniofacial surgery are some of the craniofacial synostosis syndromes, neurofibromatosis (tumors on the peripheral nerves), and some of the malignant tumors affecting the skull base. While surgery can be very helpful in these patients, there is frequently some residual deformity after treatment and the complication rate following surgery in these particular groups is higher than in others.

Risks include, but are not limited to, those typically associated with any surgery: reaction to the anesthesia used, excessive bleeding, infection, visible scarring, possible asymmetry or irregularities, and possible changes in nerve sensation. Your team representative should discuss other possible risks with you.

1. Are my objectives realistic?
2. Where is the surgery performed? How long will the procedure take?
3. How much will function improve?
4. Is it realistic to expect perfect functioning of the involved area in my particular case?
5. Would another procedure work better for me?
6. Are there other procedures that I should consider to enhance the effects of this particular procedure?
7. What kind of anesthesia is used?
8. What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many has he/she performed in the past year?) THIS IS A CRUCIAL QUESTION FOR THIS TYPE OF SURGERY. YOUR SURGEON SHOULD PERFORM THIS TYPE OF PROCEDURE REGULARLY.
9. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
10. Will you repeat or correct the procedure if it does not meet agreed-upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
11. May I see “before and after” photos of recent patients?
12. May I have the names and contact information for several recent patients? (Follow up and get firsthand information on the procedure and surgeon.)
13. Could I observe the exact procedure I am considering before I decide to have the surgery? (Either on videotape or in person)
14. What should I expect post-operatively, in terms of soreness, what to watch for, medication, bathing/showering/swimming/eating/drinking/sleeping lying down, and levels of activity?
15. Who will be assisting during the surgery? What are their qualifications? (You should receive profiles from everyone on the surgical team)
16. Have you ever had your malpractice insurance coverage denied, revoked, or suspended?
17. Do you offer patient financing?

• Tell your doctor about any allergies you have (to foods, drugs, environmental elements).
• Tell your doctor if you have any serious medical condition(s).
• Tell your doctor about all medications you are taking (both prescription and non-prescription).
• Carefully follow any instructions your surgeon gives you regarding eating and drinking, smoking, and vitamins.
• Avoid aspirin and aspirin-containing medicines, as well as anti-inflammatory medicines such as Nuprin, Motrin, and Advil for two weeks prior to surgery. Also avoid herbal remedies such as St. John’s Wort, gingko biloba, some types of Chinese black mushrooms and other natural medicines and foods that may thin the blood.
• Arrange for someone to drive you home after surgery. Also, make plans for getting help for awhile when you first return home.

The information on this web site is intended only as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

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