Type of Surgery
Information
Last updated: 11/24/2009
Medical and surgical
Children who have had reconstructive surgery for congenital abnormalities are usually taken to a pediatric intensive care unit for a day or two, and remain in the hospital for a total of four to five days....
Adults who have had reconstructive surgery following trauma may be monitored in an intensive care unit for one to two days after the operation, particularly if they required special treatment for airway problems. The total length of the hospital stay varies according to the severity of the patient's other injuries; some burn victims may be hospitalized for several months.
Short-term aftercare includes medications for pain, changes of surgical dressings, breathing exercises, and antibiotics to reduce the possibility of infection. Patients with injuries to the jaw or mouth may be given special semi-liquid or soft diets. Children are restricted from swimming for two months after reconstructive surgery and from more active sports for six months.
Long-term follow-up may include revision surgery six to 12 months after facial trauma. In the case of children, the patient will be followed until his or her growth is complete; most will need periodic consultations with an orthodontist as well as with the plastic surgeon. A dentist or an oral surgeon should check on patients who have had craniofacial surgery following trauma during their recovery to make sure that the teeth and jawbones are in proper alignment. All Le Fort fractures (I, II, and III) involve damage to the patient's normal occlusion (bite pattern).
Some patients may choose to have cosmetic surgery to remove or minimize facial scars after healing is complete, usually about six months after the reconstructive operation.
Psychological
The psychological aftereffects of a disfiguring congenital abnormality or post-traumatic injury are often problematic. Craniofacial reconstruction in children with congenital syndromes typically includes ongoing psychological assessment and counseling to help the parents as well as the child cope with feelings of guilt as well as deal with teasing or ridicule from others. Many parents blame themselves for their child's condition if it is associated with a genetic disorder. Children who have had a disfiguring injury often develop post-traumatic stress disorder (PTSD), depression, or anxiety. One study found that 98% of children between the ages of three and 12 who had been disfigured by accidents or dog bites had symptoms of PTSD within five days of the traumatic event. A year later, 44% of the children still had symptoms, and 21% met the full diagnostic criteria for PTSD. Psychiatric symptoms in children are often intensified as the youngsters reach adolescence and become even more preoccupied with their appearance.
Adult patients also have high rates of depression, PTSD, or anxiety disorders following craniofacial reconstruction. Support groups as well as individual psychotherapy appear to be effective in helping people learn to live with disfiguring injuries or the aftermath of cancer surgery. Specific concerns include coping with awkward social situations as well as internal feelings of guilt or anger. Some researchers have reported that men find it harder to adjust to facial disfigurement than women, possibly because males in Western societies are not encouraged to discuss concerns about their appearance.
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A child undergoing surgery on the skull. (Photograph by Alexander Tsiaras. Science Source/Photo Researchers. Reproduced by permission.)
To repair severe fractures around the nasal bone (A), an incision is made into the patient's skin at the top of the head (B). The skin is pulled off the face to expose the fracture (C), which then can be repaired with plates and screws (D). (Illustration by GGS Inc.)
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Definition
Craniofacial reconstruction refers to a group of procedures used to repair or reshape the face and skull of a living person, or to create a replica of the head and face of a dead or missing person. The word "craniofacial" is a combination of "cranium," which is the medical word for the upper portion of the skull, and facial. Craniofacial reconstruction is sometimes called orbital-craniofacial surgery; "orbital" refers to the name of the bony cavity in the face that surrounds the eyeball.
Purpose
Craniofacial reconstruction has several different purposes depending on the group of patients or persons in question. In children, craniofacial reconstruction is done to repair abnormalities in the shape of the child's skull and facial features resulting from birth defects or genetic disorders. It is also done to repair traumatic injuries resulting from accidents or child abuse. Craniofacial reconstruction in children requires special techniques and planning because the surgeon must allow for future growth of the child's facial bones and skull.
In adults, craniofacial reconstruction is most commonly done following head or facial trauma, but it is also performed on cancer patients who have lost part of the bony structures or soft tissue of the face following tumor surgery. In both adults and children, the reconstruction is intended to restore the functioning of the patient's mouth, jaw, and sensory organs as well as improve his or her appearance. Craniofacial reconstruction is a complicated procedure because the surgeon is operating on a part of the body that contains the brain and upper part of the spinal cord, the eyes, and other sensory organs, and the opening of the patient's airway—all within a small space.
The third major application of craniofacial reconstruction is in forensic medicine and anthropology. Forensic is a term that refers to legal matters. Physicians who specialize in forensic science study the remains of people who have died to establish not only the cause of death but in some cases, the identity of the dead person. Craniofacial reconstruction is one approach to this identification. Anthropologists, the scientists who study the origins and cultural development of humans, make use of craniofacial reconstruction to understand what prehistoric people looked like and to compare them with
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