Severe cranio-facial deformities and their management.

Historical attitudes to cranio-facial deformities are discussed. A simple nosology of cranio-facial deformities is given, the main groups being craniosynostosis syndromes, facial clefts, tumours, trauma, facial microsomias, and midface hypoplasias. Each group is briefly discussed, with emphasis on the craniosynostosis syndromes and facial clefts. Cases from these two groups are illustrated before and after surgery, showing the dramatic improvement offered by cranio-facial techniques. The basic principles of cranio-facial surgery are briefly discussed, and the complications discussed. The South Australian Cranio-Facial Unit experience with complications is discussed, especially blindness and persistent C S F leaks. The necessity for only a few cranio-facial units each with a high workload is reiterated, and new directions for cranio-facial surgery discussed, including the use of microvascular techniques and early surgery to minimise later deformity, particularly in cases with plagiocephaly.