Plastic Surgeons, Oral surgeons, ENT surgeons, and Neurosurgeons are often attributed to the areas of craniofacial and maxillofacial surgery. What are the differences between the two fields? Craniofacial surgery is an area dedicated to the reconstruction of the skeletal structures of the skull and facial bones. Maxillofacial surgery focuses on reconstruction of facial and jaw bones, and the teeth. There is overlap of the two disciplines and frequently plastic surgeons will have expertise in both.
Craniofacial surgery is often associated with pediatric plastic surgery as well. Infants that are born with various craniofacial syndromes and anomalies can exhibit mild to severe deformities of the skull and facial bones. In a condition called craniosynostosis, premature fusion of the soft skull bones of a newborn and lead to characteristically abnormal head shapes. This fusion causes restriction of skull growth in the affected area causing increased intra-cranial pressure and can lead to mental retardation or developmental delays. Surgery is typically performed in the first 3 to 24 months of life to remove the abnormal bone, reshape it, and re-affix the bone onto the skull base. This allows for correction of the contour deformity and increased intra-cranial space to relieve the excess pressure on the brain. A neurosurgeon and plastic/craniofacial surgeon usually comprise the “team” of doctors.
Other craniofacial abnormalities can result from tumor excisions or lack of facial growth. Other techniques for reconstruction can be utilized such as bone grafting and distraction. Distraction refers to a strategy of cutting bone and gradually “stretching” it by increasing a gap between the bone segments. The “gap” then eventually fills in with new bone that heals to the surrounding bone. Mandibular Distraction is a procedure that is often performed in children with jaw deformities such as micrognathia (small jaw) in Pierre-Robin Sequence or with Hemifacial Microsomia (asymmetric jaw).
Surgery of The Face and Jaw
Maxillofacial surgery employs many of the same techniques that are used in craniofacial surgery, but this field has a stronger association with trauma reconstruction. Maxillofacial injuries are typically caused by motor vehicle collisions, sporting injuries, and assaults. Maxillofacial surgeons are faced with the difficult challenge of repairing fractured facial and jaw bones. Through various incisions in the face, mouth, and eyelids, the facial skeleton is exposed and the fractures re-aligned (“reduced”). Fractured fragments are then stabilized with titanium plates and screws. Sometimes, absorbable plates and screws are also utilized – especially in children and infants with facial trauma.
Fractures of the lower jaw (or mandible) can often lead to abnormal bite configurations and injuries to the teeth. Additional expertise is needed when dealing with associated dental injuries or trauma to the TMJ (the hinge joint of the lower jaw). Temporary wiring of the teeth is often necessary to restore pre-traumatic occlusion (bite) prior to reducing and fixating the fracture. Early motion of the lower jaw after surgery is important to avoid scar tissue and stiffening of the hinge joint.
Other clinical problems requiring maxillofacial surgeons include tumor excisions and bony defects of the upper and/or lower jaws. Bone grafts are most commonly utilized for reconstruction. Occasionally bone grafts are not sufficient for reconstruction of large gaps, and microsurgical transfer of bone is necessary. Dental restoration is usually performed in conjunction with dentists and prosthodontists. Maxillofacial surgeons typically will assist in this process by placing implants in the jaws and/or bone grafting if necessary.
Dr. Ha has expertise in craniofacial and maxillofacial surgery and performs a wide variety of procedures in both children and adults. He completed his Craniofacial and Pediatric Plastic Surgery fellowship at UT Southwestern and currently serves as the director of Plastic Surgery Maxillofacial Trauma at Baylor University Medical Center. He also is a faculty member of the AO North America, an organization dedicated to the study and teaching of Cranio-maxillofacial Trauma Management. Mor information can be found at www.kidsplastsurg.com.
The procedures that Dr. Ha commonly perform include:
• Facial Fractures
• Secondary Facial deformities from trauma
• Mandible Fractures
• Nasal Reconstruction
• Facial Osteotomies
• Cranial vault remodeling for craniosynostosis
• Mandibular (jaw) distraction
• Bone grafts
• Chin advancement (genioplasty)
• Jaw advancement (LeFort osteotomies)
• Microvascular bone reconstruction
• Facial reconstruction after bony cancer excision