Interaction of craniofacial dysmorphology, growth, and prediction of surgical outcome

Craniofacial surgery is a multidisciplinary specialty that often uses the expertise of many specialists including surgeons, orthodontists, geneticists, and anthropologists. The clinical experience gained by their collaboration enables predictions to be made of the ultimate success of the reconstructive surgery. Various patterns among surgical outcomes are noted as greater experience is gained. These observations prompted the following questions: Is there a way to classify patients according to surgical results? What factors underlie a successful response to surgery? In a clinical setting, we are faced with a spectrum of presentations of craniofacial dysmorphology. We propose that the results of surgical correction may be based on the cause of the condition and not necessarily on the degree or character of the dysmorphology. Craniofacial dysmorphologies are often grouped under the terms deformation, malformation, disruption, dysplasia, or syndrome. Our hypothesis is that a categorization of craniofacial dysmorphology can be proposed on the basis of the response of the individual to surgery. We propose that such a classification reflects real differences in cause. A poor response to surgery reflects a condition that includes a growth disorder. Alternatively, cases that respond best to surgery are those in which the growth process is not affected. In the latter cases, a dysmorphic face is surgically transformed into an acceptable morphology, and normative growth vectors maintain or improve postoperative facial appearance. It is our belief that the physiological differences underlying our categorization scheme have to do with embryological timing of insults or specific components of the ontogenic process. The divergence in the response to surgery among patients relates directly to the role of the growth process in the various types of dysmorphologies.