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Head and face reconstruction
Definition
Head and face reconstruction is surgery to repair or reshape deformities of the head and face (craniofacial).
See also:
Alternative Names
Craniofacial reconstruction; Orbital-craniofacial surgery; Facial reconstruction
Description
How surgery for head and face deformities (craniofacial reconstruction) is done depends on the type and severity of deformity, and the patient's condition.
Surgical repairs involve the skull (cranium), brain, nerves, eyes, facial bones, and facial skin. That is why sometimes a plastic surgeon (for skin and face) and a neurosurgeon (brain and nerves) work together. Head and neck surgeons also perform craniofacial reconstruction operations.
The surgery is done while you are deep asleep and pain-free (under general anesthesia). The surgery may may take 4 to 12 hours or more. Some of the bones of the face are cut and moved. During the surgery, tissues are moved and blood vessels and nerves are reconnected using microscopic surgery techniques.
Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in spaces where bones of the face and head were 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. To cover the holes, flaps may be taken from the hand, buttocks, chest wall, or thigh.
Sometimes the surgery can cause a lot of swelling of the face, mouth, or neck, which may last for weeks. This can block the airway. You may need to have a temporary tracheotomy. A small hole is made in the neck, through which a tube (endotracheal tube) is placed in the airway (trachea). This allows you to breathe the face and upper airway are swollen.
Why the Procedure Is Performed
Craniofacial reconstruction may be done if there are:
- Birth defects and deformities from conditions such as:
- Apert syndrome
- Cleft lip or palate
- Craniosynostosis
- Crouzon's disease
- Hypertelorism (abnormally wide space between the eyes)
- Moebius syndrome
- Treacher-Collins syndrome
- Deformities caused by surgery done to treat tumors
- Injuries to the head, face, or jaw
- Tumors
Risks
Risks from any anesthesia are:
- Problems breathing
- Reactions to medications
Risks from any surgery are:
- Bleeding
- Infection
Other risks from 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
These complications are more common in people who:
- Smoke
- Have poor nutrition
- Have other medical conditions, such as lupus
- Have poor blood circulation
- Have past nerve damage
After the Procedure
You may have to spend the first 2 days after surgery 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)
These surgeries usually lead to a much more normal appearance, even though they can have risks. It is important that people who have face reconstruction avoid contact sports for 2 to 6 months after surgery.
Often some people need to have another surgery. Several procedures may be needed over a period of 1 to 4 years.
People who have had a serious injury often need to work through the emotional issues of the trauma and the change in their appearance. Both children and adults who have had a serious injury may have posttraumatic stress disorder, depression, and anxiety disorders. Talking to a mental health professional or joining a support group can be helpful.
Parents of children with deformities of the face 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, emotional symptoms may develop or get worse.
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.
Baker SR. Reconstruction of facial defects. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 24.
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.
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
