Complex Facial Defects

Complex facial defects may occur following the removal of a tumor in the throat or in one of the glands in the mouth, near the ears, or in the cheeks. Other times, a patient may come to an ear, nose, and throat doctor because of issues related to a defect that was present at birth. Depending on what specific areas are affected, deformities of this nature may affect the ability to breathe, chew, swallow, or sleep.

• Some defects are primarily cosmetic in nature, as may be the case with tumor removal that alters facial shape.
• Correcting such defects usually involves surgery to restore function and appearance.

Congenital deformities affecting the skull and facial bones are ones that were present at birth. Craniofacial deformities primarily affect the skull. Maxillofacial deformities affect the upper jaw. If teeth and nearby bony structures are affected, a patient has dentofacial deformities. Specific defects that may appear within the various parts of the face include:

• Cleft lip: Upper lip is split and/or separated.
• Cleft palate: A gap in the palate or roof of the mouth.
• Craniosynostosis: Skull bones prematurely fused.
• Deformational plagiocephaly: Asymmetrical shape of the head.
• Hemifacial microsomia: Under-developed bone or soft tissues of the jaw, ear, or mouth.
• Microtia: Improper ear development.

Facial defects that are complex in nature sometimes result when a tumor or other cancerous tissues have to be removed. If the affected tissue has a healthy blood supply, a skin graft may be all that’s needed to correct defects. Microvascular surgical techniques such as free flap surgery involve the transfer of tissue along with a blood supply that’s attached. When cancer is involved, it’s usually preferable to use tissue from a donor site that’s far from the location that was affected by cancer.

Preferably, surgical intervention for complex facial defects that are congenital should be done before a patient has reached the age of one. The goal with any type of corrective surgery is to first repair the defect and then to restore the appearance of the affected part of the face. If surgical restoration with skin grafts and tissue transfer will not effectively correct a defect alone, a prosthesis may also be used.

Reconstruction of craniofacial defects due to cancer surgery may involve a bone-anchored prosthesis. With more complex deformities, prosthetic techniques may be combined with various grafting procedures to achieve the desired results. The prosthesis may be specially designed to cover the entire defect. Some patients may require additional oral implants and a cosmetic prosthesis for full restoration. If the defect is highly visible and primarily affecting one side of the face, the other side of the patient’s face may be used a model to create the prosthesis.

When complex facial deformities are the result of tumor removal, reconstruction surgery may be performed at the same time as removal or as a secondary surgery after the patient has had some time to heal. Procedures for other types of facial abnormalities are often performed in stages to minimize patient risks and avoid excessive stress on tissues and facial structures. Follow-up therapy is sometimes recommended to improve speech and eating capabilities.