Head and face reconstruction

Description:
Surgery for head and face deformities (craniofacial reconstruction) depends on the type and severity of deformity and the condition of the patient. Generally, because surgical repairs involve the skull (cranium), brain, nerves, eyes, facial bones, and facial skin, a plastic surgeon (for skin and face) and a neurosurgeon (brain and nerves) work together.

The surgery is done while the patient is deep asleep and pain-free (under general anesthesia) and may take from 4 to 14 hours to complete. Some of the facial bones are cut and repositioned into a more normal facial structure. Pieces of bone ( bone grafts ) may be taken from the pelvis, ribs, or skull to fill in the spaces where bones of the face and head have been moved. Small metal screws and plates may be used to hold the bones in place. The jaws may be wired together to hold the new bone positions in place.

If the surgery is expected to cause much swelling of the face , mouth, or neck, the airway becomes a major concern. The airway tube (endotracheal tube) normally used for long surgical procedures under general anesthesia may be replaced with an opening and tube directly into the airway (trachea) in the neck (tracheotomy).

Indications:
Guidelines for craniofacial reconstruction include:
  • birth defects (such as hypertelorism, Crouzon's disease, Apert's syndrome)
  • injuries to the head, face, or jaws (maxillofacial)
  • tumors
  • deformities caused by treatments of tumors



What to Expect After:
Although not without risk, these surgeries usually result in a much more normal appearance.

Convalescence:
Depending on the extent of surgery and need for close monitoring of the airway, the first 2 days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave the hospital within 1 week. Complete healing may take up to 6 weeks.

Risks:
Risks for any anesthesia are:

Risks for any surgery are:

Additional risks of surgery of the head and face are:

  • nerve damage (cranial nerve dysfunction)
  • permanent scarring
  • partial or total loss of bone grafts
  • need for follow-up surgery



Cost:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: variable
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day (more for the intensive care unit (ICU) or private rooms)
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.