Our Summary

This research paper discusses how significant defects in the facial region - particularly around the forehead, nose, and eye area - can lead to severe disfigurement. These defects can be caused by tumor removal, severe fractures, or surgeries in the area.

The researchers performed reconstructive surgeries on 11 patients with these kinds of facial defects, using different methods depending on the specific case. Some patients had cartilage block with fascia grafts used to rebuild the area, others had bone grafting covered with fascia grafts, and some had small bone chips encased with fascia for smaller defects. In more complex cases, a 3D computed tomographic image was used to create a detailed replica of the area, which was then used to guide the reconstruction.

The researchers followed up with the patients for a period of 3 to 25 years after the surgery. All of the patients had good results - they had symmetrical faces and acceptable facial contours, and were comfortable attending social activities. One patient who had received a cartilage block graft came back 18 years later to have further work done to refine the facial contour.

The study concludes that these kinds of facial defects can be successfully reconstructed using a variety of methods, including cartilage grafts or bone grafts overlaid with fascia grafts. For more complex defects, 3D imaging and replica creation can be used to guide the reconstruction and achieve a symmetrical and aesthetically pleasing result.

FAQs

  1. What are some of the causes of significant defects at the fronto-naso-orbital area?
  2. What methods of reconstruction were used on the patients in this study and how successful were they?
  3. What is the role of 3-dimensional computed tomographic image reconstruction in craniofacial surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniofacial surgery is to have realistic expectations and to understand that the process may require multiple surgeries or refinements to achieve the desired outcome. It is important to follow post-operative care instructions carefully and to communicate openly with your healthcare provider about any concerns or questions that may arise during the recovery process.

Suitable For

Patients who are typically recommended for craniofacial surgery are those with significant defects at the fronto-naso-orbital area, such as those resulting from tumor ablations, compound comminuted fractures, or previous craniofacial surgeries. These patients may present with severe facial disfigurement and may require reconstruction to restore facial symmetry and function. Patients with midline fronto-naso-orbital defects can be reconstructed with carved cartilage grafts, bone grafts, or 3-dimensional computed tomographic image reconstruction to achieve a symmetric esthetic result. It is important for these patients to undergo deliberate evaluation and planning, and to be treated by skilled surgeons with experience in craniofacial reconstruction.

Timeline

Before craniofacial surgery:

  • Patient presents with significant defects at the fronto-naso-orbital area causing severe facial disfigurement
  • Patient may have undergone tumor ablations, sustained compound comminuted fractures, or previous craniofacial surgeries in the affected area

After craniofacial surgery:

  • Reconstruction is performed by the surgical team, using various techniques such as carved cartilage block with fascia grafts, split calvarial bone grafting, or drilled bone chips harvested from outer table of calvarial bone encased with fascia
  • Follow-up is conducted for 3 to 25 years post-surgery to monitor the patient’s progress
  • Patients typically achieve good results with symmetric face, acceptable facial contour, and improved willingness to attend social activities
  • Some patients may require additional refining procedures for facial contour in the years following the initial surgery
  • Individualized approaches and proficient skills in reconstruction are key to achieving successful outcomes in craniofacial surgery

What to Ask Your Doctor

  1. What are the different options for reconstruction of my fronto-naso-orbital defect?
  2. How will you determine which method of reconstruction is best for my specific case?
  3. What are the potential risks and complications associated with craniofacial surgery?
  4. What is the expected recovery time and post-operative care for this type of surgery?
  5. Will I need additional surgeries or procedures in the future for further refinement or maintenance of the reconstruction?
  6. Can you provide me with before and after photos of previous patients who underwent similar craniofacial surgeries?
  7. How experienced are you in performing craniofacial surgeries, specifically for fronto-naso-orbital defects?
  8. What is the success rate for this type of surgery, and what are realistic expectations for the outcome?
  9. Will I need to follow up with other specialists or healthcare providers after the surgery?
  10. Are there any alternative treatments or therapies that I should consider before proceeding with craniofacial surgery?

Reference

Authors: Chen SH, Ko AT, Chen HC, Roan TL, Tang YB. Journal: Ann Plast Surg. 2018 Dec;81(6S Suppl 1):S10-S14. doi: 10.1097/SAP.0000000000001606. PMID: 30161051