DEFINITION
- HISTORY
At birth, some unfortunate infants
present a significant anomaly of the shape of the skull and/or the face.
Though clefts of the lip and palate
have been treated for a long time, not much was done for the
distortions and asymmetries of the skull, the forehead, the orbits..
To treat these conditions, Paul
Tessier, a plastic surgeon from Paris, France, devised a completely new
approach that he called "Craniofacial Surgery".
The fundamental principle is to
reposition all the displaced parts of the skull in their normal
position, like one does for the skeleton of the lower or upper limbs,
and to replace the missing parts with bone grafts.
To correct the orbital and frontal
anomalies, cooperation with the neurosurgeon is essential, and it was
Paul Tessier who persuaded Gerard Guiot, a neurosurgeon working in the
same hospital as he, Hôpital Foch, to start this pioneer team
work in the Sixties..
These principles were applied
firstly to facial advancement for facial retrusions and for orbital
mobilization, to correct hypertelorism (excess width between orbits)
and orbital dystopia (orbits not at the same level).
Later, the same principles were
applied to correct a series of various congenital malformations :
craniosynostosis, lateral facial clefts, encephalocele,
neurofibromatosis, and also, to correct post-traumatic deformities and
to reconstruct after tumor removal.
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New developments are the distraction
principle, introduced in craniofacial surgery by Joseph McCarthy
from New York ; distraction is a slow progressive displacement of bone,
guided by an apparatus,
which allows repositioning in the desired position and new bone
formation.
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The development of microplate
systems, now absorbable if desired, permits an easier fixation..
The new imaging techniques have
also helped tremendously the better understanding and treatment of
craniofacial anomalies.
Genetic analysis has shown that
many of these conditions are transmitted from parents to children and
it becomes possible to evaluate the risk of transmission and determine
if a foetus is affected. The foetal ultrasound also enables to
determine early on if there is a craniofacial anomaly.
Daniel Marchac, Plastic Surgeon,
trained with Paul Tessier, and in 1976, he organized a craniofacial
team with Dominique Renier, Pediatric Neurosurgeon, at the
Hôpital Necker-Enfants Malades. Together, they have treated a
considerable number of patients, in particular, for craniosynostosis
and faciocraniosynostosis, as well as facial clefts and hypertelorism.
Eric Arnaud, Plastic Surgeon, is
now part of the team. The operations are performed In Hôpital
Necker Enfants-Malades or at the CCBB, a center for pediatric surgery.
This craniofacial team also
includes :
Pediatric
Anesthesiologists : Philippe Meyer, MD; Nabil Khouri, MD; Patrice Desruelles, MD; Christophe Legros, MD
Orthodontist and Oral Surgeon : Louis-Charles
Roisin, MD
Ophthalmologist : Pr. Duffier and Yves
Bokobza, MD
Psychologist : Mrs. Susan Concordet
Geneticists : Elizabeth Lajeunie, MD (†) and
Pr. Martin Catala
Radiologists : Pr. Francis Brunelle and Dr.
Ernest