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THE CRANIOFACIAL Center:
Advances in the Treatment of Facial Deformities
Larry A. Sargent, M.D.

Introduction
Craniofacial surgery encompasses a broad spectrum of reconstructive procedures of the cranium and face. Paul Tessier, of Paris, is considered the father of modern craniofacial surgery techniques and the originator of a new specialty. Tessier, a French plastic surgeon, concentrated initially on traumatic problems of the orbits. He developed techniques to extensively dissect the facial soft tissue from its respective bones with simultaneous intracranial exposure and circumferential mobilization of the orbits to allow radical repositioning of the eyes and skull. The main principle from which his treatment evolved is that the skeletal defects and abnormalities of craniofacial deformities must be either repositioned or reconstructed with bone grafts prior to soft tissue repair (see reference 1). By pioneering these radical concepts, he was able to correct major facial deformities previously thought untreatable.

In the past 10 or 15 years, regional centers have evolved, offering a multidiscipline team approach, as well as innovative surgical techniques to provide effective comprehensive care for these patients. evaluation and treatment of these complex problems in a regional center is essential because of the necessary multidiscipline approach and supraspecialization. The center provides a coordinated comprehensive care program for the treatment of their multifactorial physical deformities and psychosocial problems. In general, these patients are unique, and without centralization, it is not possible to maintain the necessary expertise for proper treatment. Craniofacial procedures performed on an irregular or occasional basis invite disaster and are not in the best interest of the patient. We adhere to Tessier's principles that craniofacial surgery should be performed only by surgeons who have that as their main interest, and only where they have the support facilities of a major pediatric medical center to provide safety in care and planning (see reference 2).

Case Presentations
The Tennessee Craniofacial Center at T.C. Thompson Children's Hospital and Erlanger Medical Center specializes in the evaluation and treatment of patients of all ages with facial deformities. The techniques and principles of craniofacial surgery can be applied to facial deformities from a variety of etiologies ranging from congenital problems to acute craniofacial trauma. The following examples illustrate current reconstructive techniques.

Case 1. A baby girl, referred at one week of age, was born with a large midline nasal mass that was increasing in size (Fig. 1). The visual field of the right

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The Tennessee Craniofacial Center, part of the Erlanger Health System, is located in Chattanooga, Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the evaluation and treatment of patients of all ages with craniofacial deformities. Location: 975 East Third Street. Chattanooga, Tennessee 37403
Phone: 423-778-9192 or 800-418-3223 Fax: 423-778-8172
Internet: www.craniofacialcenter.com Copyright ©1997, 2000, Erlanger Health Systems