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Larry A. Sargent, M.D.
An infant born with a facial disfigurement can often present overwhelming obstacles for his or her parents. The first question many parents ask deals with finding proper medical treatment for their child. The complexity of many craniofacial defects requires the expertise of an established craniofacial team to treat the patient.
Craniofacial Surgery - Background
Craniofacial surgery is a relatively new field being officially recognized as a subspecialty in 1967. The objective of craniofacial surgery is to correct deformities of the facial and skull bones that result from birth defects, tumors, or trauma.
Dr. Paul Tessier, a French plastic surgeon, is considered to be the father of craniofacial surgery. Tessier's techniques are based on the principle that the skeletal defect must be either repositioned or reconstructed with bone grafts before the soft tissue can be repaired. Today, modern craniofacial surgery offers new hope for the surgical correction of major facial deformities that were once thought impossible to treat.
Diagnosis and the Referral Process
Craniofacial deformities can be congenital or acquired. For those patients born with craniofacial anomalies, the obstetrician, pediatrician or family practice doctor is the initial point of contact for appropriate medical treatment. Referrals should be made to a craniofacial center as soon as it is acceptable for the child to be evaluated.
Accurate diagnosis at an early age not only avoids unnecessary emotional stress, but also minimizes potential future problems associated with the deformities by early correction. For those patients with acquired deformities as the result of trauma or tumor resection, referral to a craniofacial center may be desirable to help restore facial function and appearance. The Craniofacial Center
The care of craniofacial patients requires the expertise of super-specialized professionals from many health-care fields. Multidisciplinary teams have been established at regional centers to provide the comprehensive care necessary to adequately evaluate and treat craniofacial patients and their families. No single physician can possess the expertise to evaluate and treat all the abnormalities of these patients.
Often it is necessary for families to travel long distances to obtain care for their child. It is important to understand that many craniofacial conditions are rare and that there may not be a significant population of that defect in a given area. Multidisciplinary craniofacial teams are found at major medical centers across the United States where resources are available to provide the safest and most advanced treatment for patients with facial anomalies. Regionalization ensures that each team has a large enough patient load to maintain the necessary expertise for proper treatment. The more procedures they perform together, the better the team becomes. Consequently, operative time is decreased, complications are minimized, and results are improved.
Craniofacial procedures performed on an irregular or occasional basis invite disaster and are not in the best interest of the patient.
The Evaluation Process
Each patient referred to a craniofacial center undergoes an evaluation by the principle members of the team, generally on an outpatient basis. Additional members of the team are called in depending on the individual needs of the patient. Team members meet to discuss the evaluations and formulate a coordinated comprehensive treatment plan that addresses both the physical and psychosocial problems. At the appropriate time, the treatment plan is executed and longitudinal follow-up occurs.
Craniofacial Surgeon The craniofacial surgeon is a plastic surgeon who has received extensive additional training in craniofacial techniques and whose practice is predominantly dedicated to the treatment of facial anomalies. The plastic surgeon generally directs the craniofacial team.
Neurosurgeon The neurosurgeon evaluates patients with anomalies involving defects of the skull or orbits. The neurosurgeon and plastic surgeon plan surgical intervention and participate jointly in operations that require an intracranial approach.
Anesthesiologist The anesthesiologist administers anesthesia, assists in airway management in patients with obstructions or pulmonary problems. The anesthesiologist evaluates the patient preoperatively to assess possible risks and provides post operative follow up.
Pediatrician The pediatrician generally refers the patient to a craniofacial center and is responsible for the patient's overall medical management.
Audiologist The audiologist evaluates the patient's hearing with special tests and makes recommendations for possible ENT management, further testing, hearing aids, and preferential classroom seating.
Otolaryngologist The otolaryngologist or ENT evaluates patients for possible problems with ears, nose and throat, and provides treatment for these problems. Speech Pathologist The speech pathologist evaluates the communication skills of the patient to determine the quality of speech and language skills, identify problems, and make recommendations for intervention.
Pedodontist/Orthodontist These team members record dentition of patients, evaluate dental health and diagnose dentofacial deformities. The orthodontist works closely with the plastic surgeon on many cases, especially those involving surgical movement of the jaw.
Geneticist The geneticist has two important roles on the craniofacial team. The first is helping with the patient's specific diagnosis, especially in rare syndromes. The second is to counsel parents and family members as to any genetic implications of the defect.
Ophthalmologist The ophthalmologist screens patients with facial deformities for possible vision abnormalities. The ophthalmologist works closely with the plastic surgeon when surgical intervention requires the orbital area.
Other specialties include:Psychology, Social Work, Nursing, Prosthodontics
The patient's parents should also be considered important members of the craniofacial team. They are charged with the responsibility of making decisions for their child's future and for following through with the recommended treatment plan. It is important that the parents feel comfortable with the craniofacial team in asking questions regarding the recommendations and interventions for their child.
Getting Support
The support of other parents is important to families whose loved one has a facial deformity. The craniofacial center should be able to link you with other families who have a child with a similar defect. The center should have regular support group meetings and offer educational materials about craniofacial anomalies to parents.
(At the Tennessee Craniofacial Center all patients are evaluated by members of the craniofacial team, and a treatment plan is developed.)
"The complexity of many craniofacial defects requires the expertise of an established craniofacial team to treat the patient."
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