The Feasibility of Craniofacial Osteotomies in Infants and Young Children

Abstract

Rapid strides are being made in the use of extensive craniofacial osteotomies and skeletal remodeling for congenital deformities such as those of Crouzon's disease, craniostenoses, and various forms of orbital hypertelorism. Enormous advantages to the child and parents result from performing these corrections in infancy and early childhood. We have been able to demonstrate the feasibility of these operations in a number of children (ranging from four months to five years of age). In several, cranioplasty, orbital repositioning, and midfacial advancement have been combined in a single procedure. Significantly different surgical techniques are used for the small child (as compared with adult patients). The principal new considerations involve: (1) new monitoring techniques to maintain level of anesthesia, electrolyte balance, thermal regulation through long operations, and appropriate blood gase levels: (2) modifications in osteotomies, to allow for bone growth and to prevent undesired growth arrests, in these small skulls and faces; (3) effective use of marked bone regenerative capacity of the cranial periosteum of infants: (4) development of small tools and exposures to facilitate access to the osteotomy sites in the little skull; (5) special postoperative management of intermaxillary fixation, use of tracheostomies and respirators, role of external traction, and fresh blood transfusions.