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THE CRANIOFACIAL Center:
Advances in the Treatment of Facial Deformities...page 4
Larry A. Sargent, M.D.

Operative treatment consisted of open reduction and rigid fixation of all facial fractures utilizing craniofacial techniques. Bone grafts were further utilized to reconstruct missing bone. Postoperative recovery was uneventful and the patient's preinjury appearance has been restored (Fig. 7).

figure 7.

Figure 7. (Left) A 30-year-old man involved in a motorcycle accident sustaining severe facial lacerations and panfacial fractures. (Right) Postoperative appearance after one-stage reconstruction using craniofacial techniques (case 4).

Discussion
These examples illustrate the application of radical concepts to skeletal problems of the skull and facial bones in a wide age group of patients. A craniofacial team committed to this specialty requires expertise of super-specialized professionals from numerous health care fields (Table 1). No single surgeon can possess the expertise to evaluate and treat all the abnormalities of these patients. The goal of the team is to diagnose the physical and psychosocial problems and formulate a treatment plan. This is followed by execution of the treatment plan at the appropriate time, longitudinal follow-up, collection of data on the team's activities, and production of research on its results.

A number of advances have been made in surgical technique and technology as applied to craniofacial surgery. With the experimental evidence that membranous onlay bone grafts survive better than endochondral grafts, craniofacial surgeons, for the most part, have abandoned rib and iliac bone grafts and their associated morbidity for the longer surviving cranial bone grafts (see reference 3). This bone is available in an assortment of sizes and shapes, and can be harvested as dust or free grafts, or transposed as vascularized tissue. The techniques of harvesting and utilization of cranial bone have expanded from the field of congenital craniofacial surgery to correction of traumatic facial deformities or use in aesthetic procedures. As more experience is gained, the indications for cranial bone grafts will continue to expand rapidly.

In the past ten years, tremendous radiologic advancements have been made that have improved our understanding of craniofacial deformities (see reference 4). Improvements in diagnostic evaluation with the use of two and three-dimensional CT scans have drastically enhanced our ability to analyze these complex deformities. These scans have replaced the plain radiographs for

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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