Current surgery of craniofacial anomalies.

Craniofacial dysplasia is a term covering all types of skeletal anomalies. Craniofacial surgery has made possible the movement of any bone of the face or skull to correct such deformities. Such surgery is a new and separate subspecialty and should be limited to a few regional centers. There are numerous osteotomies available. The common ones are the Le Fort I, II, and III for advancement of different segments of the midface, orbital hypertelorism correction converting each orbit into a box, which moves medially together with the eyeball, and advancement of the forehead to correct premature coronal synostosis in infancy or forehead recession in Crouzon's or Apert's syndrome. In hemifacial microsomia, the asymmetrical skeleton is rotated about the facial midline to produce symmetry, and the mandibular ascending ramus and temporomandibular joint are constructed if absent. Combinations of the various osteotomies are possible, depending upon the type of deformity as assessed by the craniofacial team. Psychosocial study indicates that surgical correction should be undertaken as early as is technically feasible. The four main complications are death, blindness, brain damage, and infection.