Head and face reconstruction

Definition

Head and face reconstruction is surgery to repair or reshape deformities of the head and face (craniofacial).

See also:

• Cleft lip and palate repair
• Craniosynostosis repair

Alternative Names

Craniofacial reconstruction; Orbital-craniofacial surgery

Description

Surgery for head and face deformities (craniofacial reconstruction) depends on the type and severity of deformity, and the condition of the patient.

In some cases, because surgical repairs involve the skull (cranium), brain, nerves, eyes, facial bones, and facial skin, a plastic surgeon (for skin and face) and a neurosurgeon (brain and nerves) work together. Head and neck surgeons may also perform craniofacial reconstruction operations.

The surgery is done while the patient is deep asleep and pain-free (under general anesthesia), and may take from 4 to more than 12 hours to complete. Some of the facial bones are cut and repositioned into a more normal facial structure.

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 may be used to hold the bones in place. The jaws may be wired together to hold the new bone positions in place.

If the surgery is expected to cause much swelling of the face, mouth, or neck, the airway can become blocked. If this is anticipated, the patient may have what is called a tracheotomy, in which a small hole is made in the neck, through which a tube (endotracheal tube) is placed in the airway (trachea). This allows the patient to breath despite severe swelling of the face and upper airway that occurs after some operations and may last for weeks.

Why the Procedure Is Performed

Craniofacial reconstruction may be done if there are:

• Birth defects and deformities related to various conditions, including:
  • Apert syndrome
  • Cleft lip or palate
  • Craniosynostosis
  • Crouzon's disease
  • Hypertelorism (abnormally wide space between the eyes)
  • Treacher-Collins syndrome
• Deformities caused by surgery done to treat tumors
• Injuries to the head, face, or jaw
• Tumors

Risks

Risks for any anesthesia are:

• Problems breathing
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Infection

Additional risks of surgery of the head and face are:

• Nerve (cranial nerve dysfunction) or brain damage
• Need for follow-up surgery, especially in growing children
• Partial or total loss of bone grafts
• Permanent scarring

After the Procedure

Depending on the extent of surgery and the need to closely monitor the patient's breathing, the first 2 days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave the hospital within 1 week. Complete healing may take up to 6 weeks.

Outlook (Prognosis)

Although not without risk, these surgeries usually result in a much more normal appearance.

Those who have suffered a traumatic injury often need to work through the psychological and emotional issues of the trauma itself and the change in their appearance. Both children and adults who have suffered a traumatic injury may suffer from posttraumatic stress disorder, depression, and anxiety disorders. Consulting a mental health professional or joining a support group can be helpful.

Likewise, parents of children with disfiguring craniofacial deformities often feel guilty or ashamed, especially when the deformities are due to a genetic condition. As younger children grow and become aware of their appearance, psychiatric symptoms may develop or worsen.

References

Burns JL, Blackwell SJ. Plastic Surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 73.

Krakovitz PR, Koltai PJ. Pediatric facial fractures. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005: chap 202.

Urken ML, Buchbinder D, Genden EM. Reconstruction of the mandible and maxilla. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005: chap 71.