Craniofacial Reconstruction Operations (Starter)

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 metal screws and plates may be used to hold the bones in place. The jaws may be wired together to hold the new bone positions in place. To cover the holes, flaps 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. This can block the airway. For this, you will need to have a temporary tracheotomy. 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.

Craniofacial reconstruction may be done if there are:

• Birth defects and deformities from conditions such as:

• Apert syndrome

• Cleft lip or palate

• Craniosynostosis

• Crouzon disease

• Hypertelorism (abnormally wide space between the eyes)

• Moebius syndrome

• Treacher-Collins syndrome

• Deformities caused by surgery done to treat tumors

• Injuries to the head, face, or jaw

• Tumors

Craniofacial Post Psychological Effects

One of the topics that I wanted to research at the beginning of the year were the psychological effects of these reconstructive surgeries. I had not had any luck finding information in regards to this topic until now. As I have been studying in the previous posts Craniofacial Injuries have a variety of psychological side effects. Below I have summarized my findings.

The psychological aftereffects of a disfiguring congenital abnormality or post-traumatic injury are 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 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.

Craniofacial Surgery (Background) (Trauma and Birth Defects)

Today class was opened by our teacher reminding us about some dates and assignments, the remaining of the period we dedicated to researching for our thesis. Below is background on the new topic I am diving into: Craniofacial Reconstruction which not only happens when the person is born with a defect but as well as if a person suffers major trauma, this is the topic which I am most interested in about.

Background:

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. The technique was then applied to reconstructing the appearance of prehistoric humans for museums and research institutions. An important contribution to the field was the publication in 1901 of three major papers on the classification of facial fractures by René Le Fort, a French surgeon. Le Fort identified the lines of weakness in the facial bones where fractures are most likely to occur. Traumatic injuries of the facial bones are still classified as Le Fort I, II, and III fractures. A Le Fort I fracture runs across the maxilla, or upper jaw; a Le Fort II fracture is pyramidal in shape, breaking the cheekbone below the orbit (eye socket) and running across the bridge of the nose; a Le Fort III fracture separates the frontal bone behind the forehead from the zygoma (cheekbone) as well as breaking the nasal bridge. A Le Fort III fracture is sometimes called a craniofacial separation.

Following Trauma:

Craniofacial reconstruction following trauma is a highly individualized process, depending on the nature and location of the patient's injuries. Emergency workers are trained to evaluate and clear the patient's airway before treating facial injuries as such; severe injuries to the midface and lower face frequently result in airway blockage caused by blood, loose teeth or bone fragments, or the tongue falling backward toward the windpipe. The trauma team may have to intubate the patient or perform an emergency cricothyroidotomy in order to help the patient breathe. The second priority in treating traumatic facial injuries is controlling severe bleeding.

Mentors, Judges

I am in the process of securing a judge, Dr. Tiwalii is a maxillofacial and oral surgeon at UT Southwestern. I have emailed him but have not received a response. Another update I have not mentioned that I have two mentors: Dr. Chon and Dr. Bader whom are both reconstructive surgeons. They have been very supportive and enthusiastic about answering my questions. One thing that has hithered communication is the fact that Dr. Chon has been in training at the University of Colorado and it has affected the speed in which he responds to my emails. 

Presentations Concluded

Today was the last day of presentations. I presented today and it went great! I will be updating my blog like normal next class period, I will also introduce my mentors since I have not done that yet.

Presentations Part 2

Today was the second day dedicated to presentations. I do not present until the third day (Wednesday January 14, 2015).

Presentations Part 1

Today was the first day of presentations, we have a large class so they take the entirety of the class period.

Presentation to be:

The first half of the class today was devoted to our indpendent studies teacher highlighting to us the upcoming important dates regarding graduation, presentations, and prom etc. Going off into the topic of our presentations which will be starting January 9th I worked on some over the break but I did not really get a lot done. My presentation is on the last day, I checked today, January 15 so I have a little more time than my other classmates. Does not mean I can slack off, im trying to get this done as soon as possible so I can continue my research. For this presentation we have to include our mentors and such as well as our progress from the last time we presented. The guidelines this time will be stricter since we already had some experience the first time we presented. The expectations have gotten higher. Even though this is not our final presentation its the last one we will have before we actually have to present with our judges (which I have not solidified at the moment).