In some cases, surgery is needed to correct major functional problems – for example, to create more space inside the skull to enable the brain to grow, or to provide better protection for prominent eyes, or to make breathing and/or feeding easier.
As craniofacial surgery is often carried out on very young patients, parental consent and consultation is a crucial part of the treatment process. Parents will be asked to consider very carefully any surgery that is requested for purely cosmetic reasons, whereas decisions relating to the surgical correction of severe functional problems are generally easier to make.
Surprisingly, operations on the face and skull are usually accompanied by very little pain. Swelling settles in a variable length of time, but in most cases the worst of the swelling will subside within the first two to four weeks. However, it will take up to six to 12 months for all the swelling to settle completely and for the final results to be appreciated.
Complications following craniofacial surgery are uncommon, but as with any operation are not unknown. Clearly, the more complex the surgery the higher the risk of complication, but statistically even for the most complex craniofacial procedures severe complications are very rare.
What conditions might affect a patient in this area?
Conditions that commonly require craniofacial surgery include:
Romberg’s hemifacial atrophy
Craniofacial surgery can also be required to treat trauma cases that might involve injuries to the head or facial structures. The rest of this guide concentrates particularly on craniofacial surgery in children.
Who will my child see as a patient?
Children with craniofacial abnormalities will be seen by a multi-disciplinary team. This team will be made up of specialists working together to make sure that the best possible treatment is given. The specialists within a craniofacial team may include the following:
• Plastic surgeons
• Oral and maxillofacial surgeons
• Paediatric neurosurgeons
• Speech and Language Therapists
• Ear, Nose and Throat (ENT) specialists
Craniofacial surgical techniques
Many craniofacial operations involve taking bone from one place and using it for support or to fill gaps in another. This is known as bone grafting. A patient’s own bone is by far the most suitable material for this procedure, and is certainly much more reliable than any artificial material – offering longevity, good growth potential and a low risk of infection. The most common donor sites for bone grafts are the hip and skull, although bone from the ribs or the tibia are also sometimes used.
When bone is taken from the hip, it will leave a small scar about 10cm long. The hip is usually quite sore afterwards, and walking is likely to be uncomfortable for a few weeks depending on the size of the graft. For a short time after the operation, a small tube is usually left at the bone graft donor site via which local anaesthetic can be administered to relieve pain. There should be no permanent impact on the appearance or function of the hip or leg.
Genioplasty is the term used to describe any surgery to the chin which does not involve the tooth-bearing part of the lower jaw. These procedures may be used to move the chin forwards, backwards, upwards or downwards, and are usually done via an incision made inside the mouth where the lower lip joins the lower gum. The bone of the chin is cut horizontally below the level of the tooth roots, and is then moved into its new position and fixed there with wires or titanium screws. These remain in place and do not need to be removed. The incision is then closed with dissolving sutures.
Following a genioplasty, patients may experience some numbness below the lower lip for a few days. The use of an antiseptic mouthwash is critical during the recovery period, and patients should avoid using a toothbrush on the lower teeth for a week or so until the gum has completely healed.
BAOMS - British Association of Oral Maxillofacial Surgeons
Craniofacial Society of Great Britain and Ireland
Headlines - Craniofacial support group
World Craniofacial Foundation
British Oculoplastic Surgery Society