Surgical Management

Abstract

In the preceding chapter we have given our views on the natural history of the complex craniofacial deformities associated with craniosynostosis. Except in the mildest forms, we believe that operative correction is needed. Originally the responsibility of neurosurgeons, this has become the work of the craniofacial team—a partnership of plastic surgeon and neurosurgeon with specialist colleagues capable of dealing with all the technical necessities likely to arise in the treatment of the patient as a whole. For the patient and his family the operative intervention, however dramatic, may be only a grand episode in a long programme of rehabilitation. But it is the technical ability to operate that makes the programme possible. This ability, pioneered by Tessier, is based on a thorough knowledge of the pathological anatomy associated with the craniosynostoses, and with all the related problems. It is this as much as anything that justifies the centralisation of craniofacial surgery in selected units, which enables the operating surgeons to build up an experience of pathological anatomy in this exacting field. In craniofacial surgery one deals with an infinite variety of three-dimensional distortions and with a multiplicity of organ systems packed into a small space. Experience is indispensable: yet each patient has unique problems and as Tessier (1971a) has said, ‘each surgical case becomes an experimental case’ (Fig. 16.1).