Craniofacial reconstruction dates back to the late nineteenth century, when doctors in Germany and France first used it to produce more accurate images of the faces of certain famous people who had died before the invention of photography. Early craniofacial reconstructions included those of Bach, Dante, Kant, and Raphael.
In modern times craniofacial surgery has evolved into a subspecialty of plastic surgery that includes the in-depth study and reconstructive treatment of disorders of the soft and hard tissues of the face and cranial areas. This includes congenital anomalies, posttraumatic and other acquired conditions. Although craniofacial surgery includes combined intracranial and extracranial surgery, the broad scope of this subspecialty is applicable to other procedures in the craniofacial region.
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. It is also performed on patients who have lost part of the bony structures or soft tissue of the face following cancer treatment or 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.
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.