Craniofacial surgery, sometimes known as cranio-maxillofacial surgery, is a sub-specialty in its own right of both maxillofacial surgery and neurosurgery. Today craniofacial teams are essentially concentrated on the paediatric craniofacial anomalies. The principal indications for paediatric craniofacial surgery, in the early months of life, are the craniosynostoses.
The overlapping fundamental expertise of paediatric anaesthetists, paediatric neurosurgeons and paediatric maxillofacial surgeons are combined in the treatment of these conditions.
On the basis that most craniofacial syndromes are caused by premature suture fusion, or failure to develop, or even absence of growth site, it is intuitive that suture release to permit conventional growth at a time that will be most likely to allow conventional growth is the basis of treatment.
As compression of the contents of the skull is potentially lethal and the ‘neurocranium’ (the part of the skull containing the brain and eyes) develops earliest, operations which effectively cut out the affected cranial sutures to allow the brain to expand in very young children are appropriate.
The ‘viscerocranium’ (the skeleton of the face and parts of the jaw bones) develops later, in the simplistic order of: orbits (eye sockets) before mandible (lower jaw) before maxilla (upper jaw) before nose. Timed interventions to maximise growth while minimising risk make sense. In some instances, craniofacial sutures are released early, with planned operations or other interventions (such as functional orthodontics) carried out at specific times to harness natural growth periods.
In some cases, where, for example, a complete replacement of functional tissue (such as the temporomandibular joint (jaw joint)) is needed, the surgery is carried out once growth is completed although temporising procedures or interventions may take place during growth.
Next section: Craniofacial anomalies