Improvements in craniofacial reconstruction: methods evolved in 235 consecutive patients

Quality evaluation following craniofacial operative procedures is largely aesthetic and almost impossible to measure. Relapse rates are measurable, and morbidity and mortality can be determined. In our series, infections have decreased from 12.5 to 1.3 percent; operating times have been reduced from a mean of 7 1/2 to 4 hours; and blood loss has been reduced from 86 to 56 percent of the total blood volume. Methods we feel are largely responsible for these improvements are (1) maintaining separation of cranial from oronasal cavities, (2) modification of osteotomies around the orbits, (3) infant surgery and extensive use of craniectomy bone, (4) frequent use of onlay bone grafts, (5) a variety of lesser technical refinements, (6) antibiotic use and anesthetic modifications, and (7) consistent team organization. No deaths or blindness have occurred in any patients in the entire series.