Craniofacial reconstruction or orbital-craniofacial surgery treats deformities of the head and face, whether resulting from birth defects, cancer treatment or injuries to head, face, or jaws.
The most common birth defects and genetic disorders that require head and face reconstruction are:
Treacher Collins Syndrome - resulting from mutation of the human chromosome 5, this condition leads to craniofacial deformities such as an excessively small jaw and airway. In some cases, the ears may be abnormal or even missing.
Cleft Palate - a common birth defect, this affects about one in every 700 infants.
Down syndrome - this is the most common congenital disorder resulting in profound facial features such as small ears, slanted eyes and a large tongue.
Crouzon and Apert syndromes - these syndromes are usually classified together as they consist of a closing in the bones at the top of the skull. As a result, people with these syndromes have a deformed head shape and breathing problems.
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Post traumatic and post surgical reconstruction
Following cancer treatment, plastic surgeons become integral to restoration of form and function, rebuilding body parts, limbs and facial features. Often the plastic surgeons will do their work during the surgery to remove the cancer, though sometimes a second operation is the necessary for reconstruction depending upon individual circumstances. Cancers of the head or neck may need bone grafts after removal of the tumour.
Under general anaesthesia, some of the facial bones are cut and repositioned into a more normal facial structure. After cancer treatment, plastic surgery techniques can be used to remerge nerve fibres and facial blood vessels. The procedure may take from four to 14 hours to complete. 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 are sometimes be used to hold the bones in place and the jaw may be wired together to hold the new bone positions in place.
Amongst adults, traumatic injuries to the face and head can be comprised of heat, chemicals, and tears. Repairing burns requires plastic surgery while most traumas require maxillofacial surgery. Children mostly experience facial traumas due to accidents or animal bites. Whatever the trauma, after assessment, x-ray or CT imaging of the facial injury will confirm extent and detail of the fractures. The surgeon will want to correct as much as possible in a single treatment, so surgery may require up to 14 hours and involve taking bone from other areas of the body to fix deformed facial bones augmented with polymer implants to fill minor areas.
Skull base oncology
Skull base tumours can affect different parts of the cranium. For example, tumours of the anterior skull base include carcinomas of the paranasal sinuses, esthesioneuroblastomas, angiofibromas, and pituitary tumours.
Tumours in the middle part of the skull base include nasopharyngeal carcinomas, adenoid cystic carcinomas and cavernous sinus meningiomas. In the posterior skull base, one finds tumours such as acoustic neuromas (schwannomas), chordomas, chondrosarcomas and glomus tumours. Although certain tumours are treated occasionally by one specialist, the majority of cases require the skills of an interdisciplinary team.
Treatment for tumours of the skull base may involve surgery, radiation therapy, chemotherapy or a combination of therapies.