Craniofacial reconstruction; Orbital-craniofacial surgery

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 over 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 placed, 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 persist for weeks.

Craniofacial reconstruction may be done if there are:

• Birth defects (such as hypertelorism, Crouzon's disease, Apert syndrome)
• Injuries to the head, face, or jaw
• Tumors
• Deformities caused by treatments of tumors

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Risks for any surgery are:

• Bleeding
• Infection

Additional risks of surgery of the head and face are:

• Nerve damage (cranial nerve dysfunction)
• Permanent scarring
• Partial or total loss of bone grafts
• Need for follow-up surgery

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

Depending on the extent of surgery and need for close monitoring of the airway, 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.