Craniofacial surgery deals with congenital and acquired deformities of the head, skull, face, neck, jaws and associated structures. These deformities may have been present at birth (such as cleft lip) or have developed after a severe accident/assault, illness or surgery.
For children, this small area of a child’s body is very complex. It affects how the child sees, hears, breathes, chews, swallows, interacts with other people; and even how their brain grows. Surgery can be performed whilst a child is very young.
Craniofacial trauma often affects adults in motor vehicle accidents, sporting and assaults and can be treated acutely or secondarily.
Craniofacial surgery can require several procedures or may be performed in one surgery.
- EAR RECONSTRUCTION
WHAT IS EAR RECONSTRUCTION SURGERY?
Ear reconstruction is a form of surgery that can rebuild an ear damaged by trauma or cancer surgery, or an ear that is misshapen or missing due to a congenital (present at birth) disorder. The surgery repairs or rebuilds the external part of the ear called the auricle or pinna.
Ear reconstruction typically is done to treat the following conditions that affect the outer part of the ear:
- Underdeveloped ear (microtia)
- Missing ear (anotia)
- Part of an ear is buried under the skin on the side of the head (cryptotia)
- An ear is pointed and has extra folds of skin (Stahl’s ear)
- An ear is folded over itself (constricted ear)
- Part of the ear is removed or damaged as a result of cancer treatment
- A burn or other traumatic damage to an ear
- Craniofacial/hemifacial microsomia (CFM)
- After surgical excision
- After complications from otoplasty surgery
Ear reconstruction only involves the outer part of the ear. It does not change the ability to hear. Along with surgery to rebuild or repair the ear, hearing rehabilitation with an otologist may be necessary.
THE SURGICAL PROCEDURE
Several surgical approaches are available for ear reconstruction. Cartilage taken from the ribs can be used to make a framework for the ear, or a medical implant may be used instead. In some cases, an artificial (prosthetic) outer ear anchored in bone may be an option.
Ear reconstruction can take anywhere from 1-2 hours to correct minor differences, to 5-6 hours for microtia reconstruction.
Ear surgery is performed at Lingard Private Hospital or Warners Bay Private Hospital. Dr Kirstin Miteff also operates at John Hunter Children’s Hospital through the public system.
RECOVERY & HEALING
The length of a person’s recovery depends on the extent of the reconstruction. It can take up to three months for the ear to fully heal. You will generally be discharged wearing a head bandage which must be left in place for approximately 2 weeks.
Once the bandages are removed, the ears will need to be treated with care for approximately 2 weeks. Most patients are instructed to avoid sleeping on their sides for 1 to 2 weeks. It is natural for the ears to be slightly bruised and swollen after surgery and this may take several weeks to subside.
BENEFITS OF EAR RECONSTRUCTION SURGERY
- Improved facial proportions
- Enhanced overall appearance
MEDICARE CRITERIA
A medicare rebate is available for ear reconstructive surgery under item numbers 45660 and 45661. Dr Kirstin Miteff will let you know if you meet this criteria in your consultation.
- FACIAL NERVE RECONSTRUCTION
WHAT IS FACIAL NERVE RECONSTRUCTION SURGERY?
Facial nerve reconstruction is often required after trauma, post-cancer treatment or from congenital deformities.
The facial nerve serves several important functions: to be able to close your eyelids, smile, eat and perform different facial expressions. Facial nerve paralysis is a condition where the facial nerve completely or partially loses its function. It can be a result of trauma, stroke, or a viral infection.
THE SURGICAL PROCEDURE
Your condition, age and other illnesses will form the basis of the type of reconstruction. Facial nerve reconstruction surgery can take the form of static or dynamic procedures.
STATIC PROCEDURES
These procedures do not produce any restoration of movement to the paralysed muscles. Only the cosmetic look is improved. Examples of this include facelift and eyelid lid surgeries that can restore symmetry to the face, and reduce facial droop. These procedures will not restore movement to the face.
DYNAMIC PROCEDURES
These are procedures that attempt to restore function in the facial muscles. The aim of this surgery is functional and cosmetic. The procedures involve substituting lost mobility of facial muscles with a transplanted and innervated muscle (typically from the inner thigh). These procedures help with the movement of the facial muscles – helping the muscles to smile, frown, and make facial expressions.
RECOVERY & HEALING
The recovery of facial nerve repair depends on the original injury and the performed procedure. In general, the surgery may take 2 weeks to heal and for most of the bruising to resolve. Recovery may take longer with larger surgeries like facelift surgery or facial muscle transfers.
The functional and cosmetic outcomes with dynamic procedures might need 12 months or longer to reach their full potential. During this time, the implanted nerves and/or muscles will grow into their new functions and the brain will learn how to better control them.
Static surgeries, like eyelid lift and facelift surgery, usually provide fast results and the cosmetic result will be immediate.
BENEFITS OF FACIAL NERVE RECONSTRUCTION
Static procedures benefits include:
- Better facial symmetry (The paralysed side will look less droopy)
- Better eye symmetry, and improved ability to close the eyes
- Reduced smile deformity. More symmetric mouth and lips
- Less eye irritation and inflammation
Dynamic procedures benefits include:
- More coordinated and symmetric facial expressions
- Restored motor abilities and facial function
- Restored ability to blink and close the eyes
- Improved eating and drinking abilities
MEDICARE CRITERIA
Facial nerve reconstructive surgery is usually covered by Medicare and health funds. Dr Kirstin Miteff will let you know if you meet this criteria in your consultation.
- ORTHOGNATHIC SURGERY
WHAT IS ORTHOGNATHIC SURGERY?
Orthognathic surgery is also known as corrective jaw surgery. It is a surgery designed to correct conditions of the jaw and face related to structure, growth, sleep apnoea, TMJ disorders, or other orthodontic problems that cannot be easily treated with braces. It corrects irregularities of the jaw bones and realigns the jaws and teeth to improve the way they work. It may also improve facial appearance.
Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies.
Jaw surgery may help to:
- Make biting and chewing easier and improve chewing overall
- Correct problems with swallowing or speech
- Minimise excessive wear and breakdown of the teeth
- Correct bite fit or jaw closure issues, such as when the molars touch but the front teeth don’t touch (open bite)
- Correct facial imbalance (asymmetry), such as small chins, underbites, overbites and crossbites
- Improve the ability of the lips to fully close comfortably
- Relieve pain caused by temporomandibular joint (TMJ) disorder and other jaw problems
- Repair facial injury or birth defects
- Provide relief for obstructive sleep apnoea
THE SURGICAL PROCEDURE
The surgery is performed under general anaesthesia and involves a hospital stay of approximately 2-5 days.
The surgery can usually be performed inside your mouth, eliminating facial scars on your chin, jaw or around the mouth. In some instances, small incisions may be required outside of the mouth.
Incisions will be made in the jawbones which allow for the movement of the jaw into the correct position. Once the jaw movement is complete, tiny bone plates, screws, wires and rubber bands may be used to secure the bones into the new position. The screws become integrated into the bone structure over time. In some cases, extra bone may be added to the jaw through the transfer of bone from the hip, leg or rib.
Jaw surgery may be performed on the upper jaw, lower jaw, chin or any combination of these.
You will require a referral from your orthodontist whom we will liaise with throughout your treatment. Careful coordination between the surgeon and orthodontist is essential to ensure that the teeth will fit correctly after the surgery.
Orthognathic surgery is performed at :
Private Hospitals
- Lingard Private Hospital
- Warners Bay Private Hospital
Public Hospitals
- John Hunter Hospital
If you choose to have your surgery at a Private Hospital we will provide you with a quotation on the day of your consultation. Should you choose to have surgery in a Public Hospital you will not be charged a surgery fee, however, you will go on a waitlist for surgery.
RECOVERY & HEALING
The duration of surgery and the period off work vary with the complexity of the surgery.
BENEFITS OF ORTHOGNATHIC SURGERY
- A more balanced appearance of your lower face
- Improved function of the teeth
- Health benefits from improved sleep, breathing, chewing and swallowing
- Improvement in speech impairments
- Improved appearance
MEDICARE CRITERIA
We encourage our patients to check with their health fund to see if they are covered for surgery before their consultation/surgery. If the surgery is of a cosmetic nature such as ‘facial augmentation’, it will not be covered by Medicare.
Orthognathic surgery to correct functionality and growth abnormality should be covered by Medicare under the specialty of Oral & Maxillofacial Surgery. It should also be covered under the Cleft Lip and Cleft Palate Scheme.
Dr Kirstin Miteff will let you know if you meet this criteria in your consultation.
With any procedure you choose to undergo, potential risks and complications can occur, and it is vital to understand them before deciding on surgery.
Some general complications and risks associated with ear reconstructive surgery may include:
- Bleeding and wound infection (treatment with antibiotics may be needed)
- Pain, bruising and swelling around the operated site(s)
- Reaction to general anaesthesia – short-term nausea, chest infection, sore throat
- Scarring – While scars from the surgery are permanent, they’re often hidden behind the ear or within ear creases
- Allergic reaction to sutures, dressings or antiseptic solutions
- The formation of a large blood clot (haematoma) beneath an incision site, which may require drainage
- Slow healing, often related to smoking or diabetes
Specific risks and complications associated with ear reconstructive surgery include:
- Scar contraction – Surgical scars can tighten (contract) as they heal. This might cause the ear to change shape, or it may damage the skin around the ear.
- Skin breakdown – Skin used to cover the ear framework may break down after surgery, exposing the implant or cartilage underneath. As a result, another surgery may be needed.
- Damage at the skin graft site – If skin is taken from another part of the body to form a flap to cover the ear framework — this is called a skin graft — scars may form where the skin was taken. If skin is taken from the scalp, hair may not grow back in that area
- Asymmetrical ears – further surgery may be necessary to correct symmetry problems or irregularities in the cartilage
- Re-protrusion of one or both ears – may occur and require further surgery
- Nausea and loss of balance related to fluid accumulation within the inner ear
- Temporary or permanent loss of sensation in the skin around the surgical site and the surface of the ear
- Small areas of skin overlying the cartilage of the ear may die, causing an ulcer that may take several weeks to heal
Dr Kirstin Miteff will go into more depth about the associated risks and complications during your consultation.
With any procedure you choose to undergo, potential risks and complications can occur, and it is vital to understand them before deciding on surgery.
Some general complications and risks associated with facial nerve reconstructive surgery may include:
- Bleeding and infection
- Negative interactions with anaesthesia or other medication
- Changes in sensitivity to the affected area
- Nerve grafts from other areas of the body may also result in sensitivity changes at the donor site
Nerve regeneration is a slow process and total recovery can take many months depending on the injury. Although facial nerve surgery can greatly improve your quality of life, full recovery in some cases can take years.
Dr Kirstin Miteff will go into more depth about the associated risks and complications during your consultation.
With any procedure you choose to undergo, potential risks and complications can occur, and it is vital to understand them before deciding on surgery.
Some general complications and risks associated with orthognathic surgery may include:
- Blood loss
- Infection
- Pain and swelling
- Nerve injury
- Jaw fracture
- Relapse of the jaw to the original position
- Problems with bite fit and jaw joint pain
- Need for root canal therapy on selected teeth
- Loss of a portion of the jaw
- Problems with eating that can be addressed with nutritional supplements or consultation with a dietitian
- A brief time of adjustment to a new facial appearance
- Need for further surgery
Dr Kirstin Miteff will go into more depth about the associated risks and complications during your consultation.