Complex Facial Deformities
Complex Facial Surgeries:
A genetic condition, wherein all the growth sutures of the skull are fused prematurely, leading to a small skull and to a severe deficiency of the midface. It is corrected by advancing the front of the skull and later advancing the entire face including the eyes and nose to make for a normal appearance. All this can be done in a single operation, and the entire process completed on the same day itself.
Treacher Collin Syndrome
Sometimes the degree of the deformity or deficiency is so severe that it cannot be corrected in a single session. Here a very innovative technique called Distraction Osteogenesis is used to move the bones of the skull or face forward at the rate of 1 mm a day using special mechanical devices. One can practically grow the bone by as many centimetres as required and along with it , other structures like nerves and muscles also grow , thus completing the formation of a normal facial structure.
In Treacher Collin Syndrome, the lower jaw is so deficient that the child is unable to breathe right from the day of birth. This often necessitates making a hole in the trachea and allowing the child to breathe through that for several years until the jaw grows to a reasonable size, but using distraction osteogenesis, one can actually grow the bone right from day one , such that the child can breath normally in less than a month after the procedure.
- Hemifacial microsomia is a craniofacial malformation resulting in a variable degree of hypoplasia of the structures within the first and second branchial arches and the nasal placode.
- Cohen suggests that the birth prevalence is likely to be around 1/5600 live births.
- Congenital hypoplasia is generally unilateral, whereas in 5% to 15% of patients bilateral involvement occurs.
- In most patients, microtia or other auricular or preauriculor abnormalities (preauricular tags on sinus pits) may present the mildest manifestation.
- Involvement is not always limited to facial structures. Cardiac, renal, additional skeletal, and other more unusual anomalies may also occur.