Craniofacial Resection and Reconstruction Surgery

Reconstructive surgery

Dear Doctor: The patient underwent partial resection and reconstruction of the craniofacial region due to osteomyelitis of the right mandible and atrophy of the contralateral masticatory muscles.
Could you please explain what partial resection and reconstruction of the craniofacial region entails? What does the surgical procedure include? Thank you.

Karen, 20~29 year old female. Ask Date: 2001/05/31

Dr. Luo Qihua reply Plastic Surgery

What you are referring to is "mandibular resection and reconstruction surgery," which includes both resection and reconstruction components.
Resection involves the complete removal of the infected area due to bacterial infection (osteomyelitis).
If the affected area is small and only the lesion is excised without segmental resection of the mandible, then during the reconstruction surgery, there is generally no need to consider fixation and reconstruction of the bone.
However, if the lesion is larger and requires segmental resection of the surrounding bone, then the reconstruction surgery must take into account the reconstruction of the bone as well.
Regarding the reconstruction part, after the resection of the mandible, along with the atrophy of the original lateral chewing muscles, there will be a significant tissue defect that affects both appearance and chewing function.
Therefore, free flap microsurgery is needed for reconstruction, which involves harvesting tissue such as skin flaps, muscle, or even bone from other areas like the upper or lower limbs and transplanting it to the head, followed by vascular anastomosis.
The success rate for improving facial appearance through this surgical procedure can reach 90% or even over 95%.

Reply Date: 2001/05/31

More Info

Craniofacial resection and reconstruction surgery is a complex surgical procedure primarily aimed at addressing tumors or severe infections in the craniofacial region, which includes the skull, face, and jaw. In your case, the patient underwent this surgery due to osteomyelitis of the right mandible and atrophy of the contralateral masseter muscle. Understanding this procedure requires a grasp of its components, indications, and the reconstruction techniques involved.

What is Craniofacial Resection?
Craniofacial resection involves the surgical removal of a portion of the skull and facial bones. This procedure is often performed to excise tumors that are located in the craniofacial region, which may include malignant or benign growths. In cases of osteomyelitis, as seen in your patient, the surgery may be necessary to remove infected bone tissue to prevent the spread of infection and to allow for proper healing.

Indications for Surgery
The primary indications for craniofacial resection include:
1. Tumors: Malignant or aggressive benign tumors located in the craniofacial area.

2. Infections: Severe infections, such as osteomyelitis, that do not respond to conservative treatments.

3. Trauma: Reconstruction following traumatic injuries that affect the craniofacial structure.

4. Congenital Deformities: Correction of congenital anomalies affecting the skull and face.

Surgical Procedure
The surgical procedure typically involves several key steps:
1. Preoperative Assessment: This includes imaging studies such as CT or MRI scans to assess the extent of the disease and plan the surgical approach.

2. Anesthesia: The patient is placed under general anesthesia for the duration of the surgery.

3. Incision: A surgical incision is made, often following the natural contours of the face to minimize scarring. The incision may extend from the scalp down to the jawline.

4. Resection: The surgeon carefully removes the affected bone and surrounding tissue. In the case of osteomyelitis, this may involve excising the infected mandible and any necrotic tissue.

5. Reconstruction: After resection, reconstruction is performed to restore the anatomy and function of the craniofacial region. This may involve:
- Bone Grafting: Using bone from another part of the body or synthetic materials to reconstruct the mandible.

- Soft Tissue Reconstruction: Utilizing local or free flaps to cover the surgical site and restore facial contours.

- Dental Implants: If necessary, dental implants may be placed to restore function and aesthetics.

6. Closure: The incision is closed in layers, and drains may be placed to prevent fluid accumulation.

Postoperative Care and Rehabilitation
Postoperative care is crucial for recovery. Patients may require:
- Pain Management: To manage discomfort following surgery.

- Antibiotics: To prevent infection, especially given the history of osteomyelitis.

- Physical Therapy: To regain function, particularly if the jaw's movement is affected.

- Regular Follow-ups: To monitor healing and detect any complications early.

Conclusion
Craniofacial resection and reconstruction is a significant surgical intervention that requires a multidisciplinary approach, involving surgeons, oncologists, and rehabilitation specialists. The goal is not only to remove diseased tissue but also to restore the patient's functional and aesthetic aspects of the face. Given the complexity of the procedure, it is essential for patients to have thorough discussions with their surgical team regarding the risks, benefits, and expected outcomes of the surgery.

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