Reconstructive Surgery
Head and Face Surgery(Craniomaxillofacial Surgery)
Long after the eras in which malformed babies were deified or, quite the opposite, destroyed, the idea that these deformities could be treated was put forward.
About Head and Face Surgery
What is Head and Face Surgery?
Long after the eras in which malformed babies were deified or, quite the opposite, destroyed, the idea that these deformities could be treated was put forward. At first, attempts were made to repair craniofacial deformities with simple skin sutures; later came the turn of anatomical corrections. In 1890 Marie-Lannelongue published the first craniosynostosis operation. In the 1950s, Gillies and Harrison tried to perform midface advancement in craniofacial dysostosis with the Le Fort III osteotomy, which was in fact frequently used in trauma cases, but unfortunately met with failure. The first important success was achieved in 1960 by Paul Tessier with the surgical reconstruction of the cranium and midface in patients with Apert and Crouzon syndromes. In 1967, Tessier again showed, by mobilising the orbits and bringing them together at the midline, that the only solution to the problem of hypertelorism was the intracranial approach. Paul Tessier's contribution that deserves the most emphasis is that he saw that craniofacial surgery is not a “one-man show” and formed a multidisciplinary craniofacial team.
The knowledge, views and contributions of scientists from different disciplines make the patient's diagnosis and treatment more accurate and faster. This team mainly includes a plastic surgeon, neurosurgeon, orthodontist, radiologist, medical geneticist, ophthalmologist, ENT specialist, anaesthetist, psychologist, physical medicine and rehabilitation specialist, speech therapist, as well as a medical photographer and an illustrator.
The diagnosis is made with a full clinical examination, review of the family and personal history, cephalograms, 3D CT, MRI and 3D photography. Examining the genetic make-up of the family is important. In addition to the anomalies of the cranium and face, deformities in other parts of the body, especially the hands and feet, are carefully investigated. Preparing a comprehensive archive of various photographs of the patient forms an important part of the work.
In the evaluation of congenital anomalies by the craniomaxillofacial team, the patient's anatomical structure, the expectations of the family and patient, and the group's aesthetic understanding are combined in an effort to obtain an attractive face in addition to correcting the deformity. The family is always told that more than one operation may be needed to reach the ideal, and consent is obtained. Although the operation begins with a specific plan, certain changes may need to be made during the operation in order to come close to perfection; that is, the surgical team is not always bound to stick to the measurements made before the operation.
One of the main goals of craniomaxillofacial surgery is to bring children with deformities as close as possible to normal, especially before school age, protecting them from the ridicule and teasing of their friends, which can sometimes be very severe, and keeping their psychological state at a good level. In craniosynostosis patients, in whom head development is affected, surgical approaches are generally attempted within the first 18 months of life, when the brain grows rapidly to 2.5 times its size. However, if a marked increase in intracranial pressure (seen in 13% of single-suture synostosis and 40% of multiple-suture involvement) threatens the brain and life, performing the operation earlier is preferred. Although the 3rd month is awaited for the operation in babies with cleft lip, and the 9th month if there is a cleft palate, patients are always seen before school age and, if there is a deformity in the lip and nose region, efforts are made to correct it. In ear deformities (absence of the ear or prominent ear deformity), the age range of 4-6 years, when ear development has largely reached adult size, is awaited.
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