Childhood Craniofacial Conditions

Craniofacial surgery is the surgery of the face and skull base – using operative techniques which cross from the skull and into the face. The techniques of craniofacial surgery were defined by Dr Paul Tessier in the 1960’s for use in major developmental syndromes of the head and face. The techniques of Tessier are still widely in use in the management of childhood craniofacial conditions, such as Crouzon syndrome; and form part of a programme of care that is truly multidisciplinary, with specialists from a variety of surgical and medical specialties.

For our 'Independent' obituary to the father of craniofacial surgery, Paul Tessier, see:

www.independent.co.uk

The techniques of craniofacial surgery allow the face and skull to be dissembled and reconstructed to reshape the face for protection of the brain, airway and the eyes, or for cosmetic reasons.

The CT scan shows a technique for advancing the face used in certain craniofacial syndromes – the monobloc osteotomy:

The ‘monobloc’ is a technique that allows, in some cases, a simultaneous improvement in breathing, the protection of the surface of the eye, and defence of pressure upon the brain. It can be used in a number of related craniosynostosis syndromes. Such techniques are only undertaken within specialist centres by experienced teams, and are part of an integrated programme of care from birth to maturity.

These problems are managed in children from birth to adulthood by craniofacial teams. In the UK four such centres are accredited for supra – regional government funding based upon the quality of their care; including the Craniofacial Centre at Great Ormond Street Hospital in London, where Jonathan Britto is Consultant Craniofacial Surgeon.

Childhood Craniofacial Cancers

Craniofacial surgical techniques have a wide application in cancer care, allowing access to previously unreachable tumours in both adults and children.

Central skull base tumour extending from skull to pharynx and face. These tumours affect many important structures and can cause difficult symptoms. Craniofacial plastic surgeons, in teams with skilled colleagues, treat young people with these tumours in a coordinated programme of care.

Such tumours can be removed by a surgical team including neurosurgeons, otolaryngologists, and craniofacial surgeons. The extended care team includes oncologists, radiologists, anaesthetists, and a much wider group of doctors, nurses, and therapists.

The removal of craniofacial tumours and the reconstruction of the craniofacial complex involves a wide range of surgical techniques and the art and science of aesthetics and reconstruction.