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.

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.

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