Form, function, growth, and craniofacial surgery

The introduction of craniofacial surgery in the early 1970's provided new treatment opportunities for patients previously ineligible for care and increased the number of patients presenting to multidisciplinary teams and private practitioners. Otolaryngologists together with other medical and paramedical professionals began to see patients whose overall phenotype was relatively unfamiliar. Complex craniofacial malformations raised questions concerned with the severity of the malformation process, the effect of growth, and the effect of surgery. For example, how does the anomalous craniofacial skeleton grow? Does the deformity become worse with time? Does it get better? Or does it stay the same? Additionally, how does surgery that is designed to restore form and function affect growth of the craniofacial complex? To answer these questions, this article examines the form, function, and pattern of craniofacial growth in four categories of malformations: cleft lip and palate, hemifacial microsomia, mandibulofacial dysostosis, and two of the craniofacial synostoses, the Apert and Crouzon syndromes. Each of these malformations is amenable to surgery. The timing and effect of surgery on growth are critical to successful habilitation and are discussed as part of the natural history of those anomalies.