Type of Surgery
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Last updated: 11/24/2009
Diagnosis of the need for craniofacial reconstruction depends on the cause of the abnormality, injury, or disfigurement. The obstetrician or the child's pediatrician will often make the diagnosis of craniofacial abnormalities in children at the time...
of delivery. Some genetic disorders that are associated with congenital facial abnormalities, including Down syndrome and Treacher Collins syndrome, can be detected before birth by chromosomal analysis. In adults, the diagnosis is usually made by trauma surgeons in the emergency room or by physicians who have treated the patient for cancer.
Imaging studies, including x-ray photographs, CT scans, and magnetic resonance imaging (MRI), are used to analyze the patient's abnormalities or injuries before the operation in order to plan the surgery. The surgeon may also consult a neurosurgeon or ophthalmologist if the abnormality or injury involves the functioning of the patient's brain, spinal cord, or eyes.
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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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