Head and face reconstruction

Craniofacial reconstruction; Orbital-craniofacial surgery; Facial reconstruction

Head and face reconstruction is surgery to repair or reshape deformities of the head and face (craniofacial).

Description

How surgery for head and face deformities (craniofacial reconstruction) is done depends on the type and severity of deformity, and the person's condition. The medical term for this surgery is craniofacial reconstruction.

Surgical repairs involve the skull (cranium), brain, nerves, eyes, and the bones and skin of the face. 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 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 screws and plates made of titanium or a fixation device made of absorbable material may be used to hold the bones in place. Implants may also be used to help reshape the skull. The jaws may be wired together to hold the new bone positions in place. To cover the holes, flaps of tissue may be taken from the hand, buttocks, chest wall, or thigh.

Sometimes the surgery causes swelling of the face, mouth, or neck, which may last for weeks to months. This can block the airway. For this reason, you may need to have a temporary tracheostomy. This is a small hole that is made in your neck through which a tube (endotracheal tube) is placed in the airway (trachea). This allows you to breathe when your 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 cleft lip or palate, craniosynostosis, Apert syndrome
Cleft lip or palate
Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth.
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Craniosynostosis
Craniosynostosis is a birth defect in which one or more sutures on a baby's head closes earlier than usual. The skull of an infant or young child is ...
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Apert syndrome
Apert syndrome is a genetic disease in which the seams between the skull bones close earlier than normal. This affects the shape of the head and fac...
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Deformities caused by surgery done to treat tumors
Injuries to the head, face, or jaw
Tumors

Risks

Risks of anesthesia and surgery in general are:

Problems breathing
Reactions to medicines
Bleeding, blood clots, infection

Risks of 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
Lupus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It c...
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Have poor blood circulation
Have past nerve damage

After the Procedure

You may spend the first 2 days after surgery in the intensive care unit. If you do not have a complication, you will be able to leave the hospital usually within 1 week. More limited procedures may require shorter or no hospital stay. Complete healing may take 6 weeks or more. Swelling will improve over the following months.

Outlook (Prognosis)

A much more normal appearance can be expected after surgery. Some people need to have follow-up procedures during the next 1 to 4 years.

It is important not to play contact sports for 2 to 6 months after surgery.

People who have had a serious injury often need to work through the emotional issues of the trauma and the change in their appearance. Children and adults who have had a serious injury may have post-traumatic 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 children grow and become aware of their appearance, emotional symptoms may develop or get worse.

Open References

References

Baker SR. Reconstruction of facial defects. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

Padilla PL, Khoo KH, Ho T, Cole EL, Sirvent RZ, Philips LG. Plastic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. St Louis, MO: Elsevier; 2022:chap 69.

Skull - illustration
The skull is anterior to the spinal column and is the bony structure that encases the brain. Its purpose is to protect the brain and allow attachments for the facial muscles. The two regions of the skull are the cranial and facial region. The cranial portion is the part of the skull that directly houses the brain and the facial portion includes the rest of the bones of the skull.
Skull
illustration
Skull - illustration
The skull is the bony structure of the head and face. The cranium surrounds the brain with the temporal, frontal, parietal and occipital bones. The maxilla, or upper jaw, and the mandible, or lower jaw, support the facial features of nose, mouth and eyes.
Skull
illustration
Cleft lip repair - series
Presentation

<strong>Cleft lip repair - series</strong><p>A cleft lip is an abnormal opening in the middle of the upper lip. A cleft palate is an opening in the roof of the mouth (palate).</p>

<strong>Indication</strong><p>Cleft lip repair and cleft palate repair are indicated for repair of physical deformity and nursing, feeding, or speech problems resulting from cleft lip or palate.</p>

<strong>Procedure</strong><p>While the baby is anesthetized and asleep (general anesthesia), the tissues around the defect are trimmed and sewn together with several layers of stitches (absorbable sutures). The skin is sewn together with very small, fine stitches (sutures) to make the scar as small as possible. In cleft palate repair, tissue from the back of the mouth (pharynx) may be taken to add tissue to the deficient soft palate (this is called a pharyngeal flap). Occasionally more than one surgery is required for complete palate closure.</p>

<strong>Aftercare</strong><p>Most babies heal without complications. The cosmetic result often depends on the severity of the deformity and is usually quite good.</p>

Craniofacial reconstruction - series
Presentation

<strong>Craniofacial reconstruction - series</strong><p>There are four major bones of the face the maxilla, the zygoma, the mandible, and the frontal bone of the cranium.</p>

<strong>Indications</strong><p>Patients requiring craniofacial reconstruction have Birth defects (such as hypertelorism, Crouzon's disease, Apert's syndrome), Injuries to the head, face, or jaws (maxillofacial), Tumors, Deformities caused by treatments of tumors.</p>

<strong>Procedure</strong><p>While the patient is deep asleep and pain-free (under general anesthesia) some of the facial bones are cut and repositioned into a more normal facial structure. The procedure may take from four to 14 hours to complete. Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in the spaces where bones of the face and head have been moved. Small metal screws and plates are sometimes be used to hold the bones in place and the jaw may be wired together to hold the new bone positions in place. If the surgery is expected to cause significant swelling of the face, mouth, or neck, the patient's airway may be an area of major concern. The airway tube (endotracheal tube) normally used for long surgical procedures under general anesthesia may be replaced with an opening and tube directly into the airway (trachea) in the neck (tracheotomy).</p>

<strong>Aftercare</strong><p>Depending on the extent of surgery and how the patient is breathing, the first two days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave the hospital within one week. Complete healing may take up to six weeks.</p>

Skull - illustration
The skull is anterior to the spinal column and is the bony structure that encases the brain. Its purpose is to protect the brain and allow attachments for the facial muscles. The two regions of the skull are the cranial and facial region. The cranial portion is the part of the skull that directly houses the brain and the facial portion includes the rest of the bones of the skull.
Skull
illustration
Skull - illustration
The skull is the bony structure of the head and face. The cranium surrounds the brain with the temporal, frontal, parietal and occipital bones. The maxilla, or upper jaw, and the mandible, or lower jaw, support the facial features of nose, mouth and eyes.
Skull
illustration
Cleft lip repair - series
Presentation

Craniofacial reconstruction - series
Presentation

A Closer Look

Talking to your MD

Self Care

Tests for Head and face reconstruction

Review Date: 5/26/2023

Reviewed By: Tang Ho, MD, Associate Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Head and face reconstruction

Description

General anesthesia

Bone grafts

Tracheostomy

Why the Procedure Is Performed

Cleft lip or palate

Craniosynostosis

Apert syndrome

Risks

Lupus

After the Procedure