Craniofacial Restoration

Craniofacial Restoration In Depth

Deformities after neurosurgical procedures can be reconstructed by cranioplasty of the frontal, temporal and parietal bones. Deformities after head and neck cancer resection can be reconstructed by a number of local and regional tissue flaps. Deformities after skin cancer resection or MOHS surgery can also be reconstructed with local and regional tissue flaps.

Cranioplasty for Skull Restoration after Neurosurgery:

A number of conditions may lead to a loss of calvarial bone (the skull bone) and temporalis muscle. This may be seen after osteomyelitis infection, osteoradionecrosis from radiation therapy and neurosurgical craniotomy. When the skull bone itself is lost, a cranioplasty procedure can be performed. If the area is small, a titanium mesh implant may help recontour the defect. In larger defects, a custom cranial implant can be made based on 3-D CT scan simulation of the mirror image of the normal side.

When the bone is intact, but cranial asymmetry is severe, the patient should be evaluated for temporalis muscle atrophy.  Facial restoration can be performed in a number of ways, including fat grafting and resculpting the bone with Hydroset bone cement. This material enables recontouring of the skull with a quick setting clay-like material.

Temporalis Muscle Flap for the Restoration of Oral Defects:

Top reconstructive surgeon Dr. Tadros is one of a few specialists in the world extensively trained in Temporalis Muscle Flap Transfer for Reconstruction of select defects of the head and neck.  Unlike micro-vascular free flap transfer, the temporalis flap is a hearty muscular flap that brings its own continuous blood supply with it to the area to be reconstructed.  This flap, originating in the scalp, is most commonly used for neurosurgical procedures.  Few head and neck surgeons are experienced with harvesting this flap and translocating it under the cheek bone directly into the oral cavity to reconstruct a number of defects in the upper jaw and cheek area.

The advantages of temporalis flap repair are numerous. The most important factor is the ability to use this flap in select cases to minimize the risk of flap failure from thrombosis/clots. The alternative, micro-vascular free flap requires division and reconnection of blood vessels in a new location. The greatest utility of the micro-vascular free flap is transfer that is unrestricted by location.  The major disadvantage is the risk of thrombosis/clot failure.

The temporalis flap is rotated under the cheek bone from the scalp without dividing its blood supply; thereby minimizing the risk of post-transfer clots and failure.  Unlike a free flap, the temporalis flap only provides soft tissue and is restricted by the distance of its blood supply, limiting its applicability to soft tissue defects of the upper jaw, cheek and lip support. The flap is robust and hearty, elegantly restoring defects as long as they are within reach.

Temporalis Flap reconstruction is most useful in reconstruction of:

• Palate/Maxillectomy bone defects resulting in communication between the upper jaw and nose:  previously once only treated with a prosthetic implant similar to a large denture
• Buccal (Cheek) defects with or without Lip Reconstruction:  once only treated with a microvascular free flap

The donor site in the scalp is then fully restored by grafting the patient’s own fat from the abdomen to the temple area in the scalp, leaving abnormality in the donor site undetectable.