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Head and face reconstruction

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

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

Surgical repairs involve the skull (cranium), brain, nerves, eyes, facial bones, and facial skin. 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 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.

Alternative Names

Craniofacial reconstruction; Orbital-craniofacial surgery; Facial reconstruction

Why the Procedure Is Performed

Craniofacial reconstruction may be done if there are:

Risks

Risks of anesthesia are:

  • Problems breathing
  • Reactions to medications

Risks of surgery of the head and face are:

  • Bleeding
  • Infection
  • 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
  • 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. Without complications, most patients are able to leave the hospital within 1 week. Complete healing may take up to 6 weeks.

Outlook (Prognosis)

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

It is important not to participate in 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. Both 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 younger children grow and become aware of their appearance, emotional symptoms may develop or get worse.

References

Baker SR. Reconstruction of facial defects. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 24.

McGrath MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

Updated: 5/15/2013

John A. Daller, MD, PhD., Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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