Craniofacial Surgery
Craniofacial surgery is a super-specialty of maxillofacial surgery and there a very few units in the world, leave alone India doing these complex surgeries. It requires a very experienced and dedicated team as these patients are usually children and needs extra special care to get best results. At Shanker Dental and Craniofacial centre we deal with these cases on a regular basis as we are one of the few centres experienced and willing to take on these complex and risky surgeries.
A 9 year old boy presented to us with complaints of an abnormally shaped head and decreasing visual acuity of 12/6. Clinical examination and CT scans showed him to have premature fusion of his cranial sutures leading to Trigonocephaly ( triangle shaped skull). The skull CT also showed a copper beaten appearance indicative of increased intracranial pressure. The plan was to do a bi-fronto-orbito bandeau advancement osteotomy
Pre-op view showing triangle shaped skull due to premature fusion of the skull joints (fontalles) which prevents the brain growth in a child . This decrease in cranial volume results in increased intracranial pressure, bulging eyes and potential decrease in vision. Decompression of the brain and providing an increase in cranial volume is vital and potentially life and vision saving.
The surgical plan for this child was a frontal bandeau advancement osteotomy as shown in the pictorial diagram.
The surgical approach is via a bicoronal scalp flap. The neurosurgical team performs a craniotomy for direct access to the frontal bone. In this picture you can see the access craniotomy has been done in preparation for the frontal bandeau osteotomy Once the craniotomy has been done, the maxillofacial team takes over and does the frontal bandeau osteotomy with extreme care.
Frontal Bandeau ostotomy being done by the maxillofacial surgeon under direct vision with extreme care taken to protect the brain and the eyes.
The frontal bandeau is now osteotomized and advanced.
The space in the skull has now been increased allowing room for the brain to grow in this child. The advanced Cranial bone are then plated with titanium plates.
Pre and post-op results showing change in skull shape. The vision of the patient also improved post surgery.
Case 2: Anterior Plagiocephaly
A 1 year old baby presented to us with complaints of flattening of her forehead and her globe was pulled upward. Clinical examination and CT scans showed her to have premature fusion of her skull bones leading to anterior plagiocephaly. A Tessier fronto-orbital advancement combined with a radial pattern frontal bone release was planned for her. The main objectives of the surgery was to release the fusion of the skull bones,decrease the intracranial pressure and also to reshape the forehead , brow and supraorbital region to a normal acceptable contour. This was to be done by a joint neurosurgical– maxillofacial team.
Preop flattering of forehead due to premature fusion of her skull bones.
Preop CT showing fusion of her skull bones on the Right side.
Bicoronal flap done and skull exposed
Access craniotomy done by neurosurgical team in anticipation of frontal bandeau tenon advancement by the maxillofacial surgeon.
The skull bones have been advanced by more than a centimetre and plated. Along with this, a radial pattern of cuts was done on the craniotomy site to allow the brain expand further as the child grows.
Pre op and post op showing change in skull shape from a flat profile to a round profile. This increases the volume and allows the brain to grow normally.
Post op after a year showing normal contour of the skull with good vision in both the eyes.