Craniomaxillofacial Reconstructive Surgery

The term reconstructive surgery connotes that surgery which seeks to rebuild, restore or return to normal those hard and soft tissues of the body that have been rendered abnormal, dysfunctional or deformed due to an event.  This event may be brought on by trauma, the resection of a tumor, or the result of a disease process. Reconstructive surgery returns to near-normal those tissues and body parts that were previously within the normal range, prior to the event.  This is in contradistinction to cosmetic surgery, which seeks to improve an already normal facial or body appearance.  Reconstructive surgery is an integral part of craniomaxillofacial surgery and encompasses a wide range of surgical procedures.  Cosmetic surgery is also performed by some craniomaxillofacial surgeons and will be addressed elsewhere

Congenital abnormalities (abnormalities that are present at birth) such as cleft lip and palate are reconstructed by craniomaxillofacial surgeons to place these tissues into proper alignment and appearance. Congenital anomalies involve tissue those abnormalities in which the event occurred within the womb, prior to birth.  In this aspect of reconstructive surgery, local tissues are almost always rearranged to create the desired effect to restore the appearance and function of the lip, palate, jaw and face.  Bone can be imported from the hip or other body parts to fill in gaps that mother nature had created.  The background of a craniomaxillofacial surgeon includes full dental education, among other things. The ability to place the reconstruction within the dental context enables the craniomaxillofacal surgeon to plan for the expectations and limitations of future growth and to work interactively with orthodontic colleagues to harness and optimize growth to produce an optimal outcome.

In trauma surgery, an obvious event such as an auto accident or gunshot wound can remove, destroy or otherwise make unusable previously normal facial body parts such as noses, eye sockets, jaws, ears and skin.  Reconstructive surgery would restore and re-create these tissues, either by rearranging local tissues or by importing new skin and bone from other body parts such as the hip, lower leg or shoulder, among many options.  The comprehensive care of the trauma patient  involves much more than facial reconstructive surgery and the craniomaxillofacial surgeon interacts with neurosurgeons and other members of the trauma team to produce an optimal outcome for the trauma patient.

Reconstructive surgery for defects created by an event involving the removal of benign or malignant tumors places the craniomaxillofacial surgeon in a dual role.  The accurate resection of these tumors is also a role of the craniomaxillofacial surgeon. The surgeon may go on during the same or during a different operation to perform the reconstruction. He or she may also utilize the services of a second craniomaxillofacial colleague to serve as the reconstructive member of the team.  Voids in jaw or other facial and neck tissues created by tumor resection are then restored, as efficiently as possible, often utilizing microvascular free flap techniques to import a living tissue along with its nutrient artery and vein.  The craniomaxillofacial surgeon then restores the effected body part(s) as accurately as possible. He or she then ensures a living blood supply to these tissues, utilizing suture finer than a human hair to delicately suture the artery of the transplanted tissue to a donor artery in the neck and likewise with one or more veins.  This microvascular technique allows the transplanted tissue to have a defined blood supply of its own.  It is immediately a living tissue within the wound or defect that is capable of healing, rather than a grafted tissue that must naturally seek out its own blood supply.  Tissue grafting is also an important component of craniomaxillofacial reconstructive surgery and the choice between a graft and a microvascular free flap is one that is best made by a highly trained craniomaxillofacial surgeon.