The craniofacial area includes the base of the skull, the facial skeleton and underlying soft tissues, the skull vaults, and the scalp. Craniofacial surgery involves repairing damage caused by serious injuries as well as congenital deformities and abnormal growths such as tumors. Congenital deformities include:
- Clefts of the lip and palate: In these conditions, all of the parts of the lip and roof of the mouth are present, but they have failed to fuse in a normal fashion. Clefts can appear with varying severity: a cleft lip can be incomplete with a fractional notching of the lip, or complete, extending through the lip and into the nose.
- Ear deformities: In these conditions, the outer ear may be underdeveloped, misshaped, or completely absent.
- Premature fusing of the bones of the head in young children: In the normal infant skull, cracks or "sutures" appear in between bones of the head to allow for brain growth. When one of these sutures closes prematurely, the brain continues to grow, but pushes out toward the area of the skull where the sutures are still open. The result is a malformation of the skull and/or face.
- Misshapen jaws: often caused by misalignment of the teeth and jaws referred to as malocclusion, or mild hypoplasia (inadequate tissue development) which can appear as a recessed upper jaw or other underdeveloped bony area of the face.
- Facial asymmetries: or hemifacial microsomia, a condition wherein one side of the face is smaller than the other, due to underdevelopment of bone and/or cartilage.
* The costs of Craniofacial Surgery varies between surgical team, type of surgery, preparatory work and post operation requirements. In some cases it may be covered by insurance.
*Each year in the United States, over 7,000 children are born with facial challenges.
Facial Deformity is one of the conditions that requires Craniofacial Surgery.
- What are the most common benefits of these surgeries?
- What will happen at the initial consultation?
- How is the surgery performed?
- How long does the surgery take?
- Where will the procedure be performed?
- How much pain is there?
- What is the recovery period like?
- What is the long-term outcome like for most people?
- Other information
- Risks and Limitations
What are the most common benefits of these surgeries?
Although the procedure for each anomaly is different, all aim for:
- Improvement or restoration of function
- Improvement or restoration of structure and appearance
- Increase in self-esteem, self-confidence, and social acceptance.
What will happen at the initial consultation?
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
- oral and maxillofacial surgery
- facial surgery
- 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 of professionals 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.
How is the surgery performed?
After appropriate assessment, surgical treatment may be recommended and this will vary considerably depending on what the particular problem is. Sometimes craniofacial surgery for deformity can be carried out without making visible scars on the face. Craniofacial surgeries carry varying degrees of risk, depending on the particular problem. Sometimes bone or cartilage grafts need to be harvested from other areas of the body such as the ribs.
How long does the surgery take?
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: two to three hours.
- Cleft palate repair: two hours
- Ear reconstruction: three to four procedures of varying lengths.
Where will the procedure be performed?
Major craniofacial surgery is done in a hospital setting under general anesthesia. You will be asleep, and will not feel anything during the surgery.
How much pain is there?
The pain following major surgery to the skull and face can be moderate to severe. Pain management includes medication administered during the hospital stay, as well prescription pain medicine for the home recovery period.
What is the recovery period like?
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 three 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 12 months.
What is the long-term outcome like for most people?
The results of craniofacial surgeries vary with the condition being treated. Bony abnormalities can be more easily corrected than those involving soft tissue. The amount of bone and soft tissue involved in the deformity will often determine the final cosmetic result that can be obtained. In general, however, surgery of this type can improve or restore a patient's functioning and appearance, improving his/her body image and self-confidence as well.
It is extremely important to research your team. Surgeons whose primary interest is outside the area of craniofacial work should not be approached for this type of surgery. The surgical team must be supported by a major medical center as well.
Risks and Limitations
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 of representative should discuss other possible risks with you.
The information on this web site is only intended 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.
*Disclaimer: Costs sources: American Society of Plastic Surgery (ASPS), nationally in 2010, and http://www.dental.pitt.edu/patients/cran.php. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may vary depending the extensiveness of the procedure, location, and other factors. Costs are provided solely for research purposes. For specific estimates, please contact a qualified plastic surgeon.