Craniofacial surgery is very much a special interest that has emerged out of neurosurgery, maxillofacial and plastic surgery for the management of head and neck problems that involve the brain and cranial cavity and complex facial structures and sometimes the neck.
Other specialities such as ophthalmology, ENT and paediatric surgery, speech and language therapy, genetics and the dental surgical specialities will be variably involved according to the nature of the individual problem.
The surgery is normally carried out in an integrated regional neurosurgical, paediatric, maxillofacial and plastic surgical unit, which drains a population area of around 2-10 million.
Care often needs to be provided over a long period from birth to adulthood. For many units, the commonest problems to be treated are related to trauma when severe injuries occur in the craniofacial area from road traffic accidents, assaults and war injuries. Many of the surgical techniques were developed in the first half of the 20th century and refined in the latter half for correction of congenital and acquired deformities which are now frequently treated.
Many of the latter are related to premature fusion of the skull sutures in infancy, which otherwise could lead to mental retardation, blindness and facial under development, as well as gross skull deformity.
There are other hereditary and congenital anomalies which variably affect the midface and lower jaw, and sometimes the skull, such as craniofacial microsomia and Treacher Collins Syndrome which may be accompanied by cleft lip and palate which require treatment.
Risk factors relating to corrective surgery may be considerable and therefore excellent communication between patient and surgeon is required, with detailed informed consent required especially when young children are involved. Many patients have other medical problems which have to be identified. Not uncommonly there is a risk to sight, hearing, taste and smell.
Speech, swallowing, mastication and the airway may all be involved and neurological damage may be difficult to avoid in certain circumstances and this all must be put to the patient and family.