Craniofacial osteotomies and rigid fixation in the correction of post-traumatic craniofacial deformities.

Post-traumatic craniofacial deformities may result from failure to diagnose craniomaxillofacial injuries or from less than adequate repair. The skeletal deformities may be corrected by procedures employing extended craniofacial exposure, segmental osteotomies and bony repositioning. A graduated approach to the correction of regional bony post-traumatic deformities has been formulated. Bony depressions are corrected by onlay grafts, rigidly fixed with lag screws. Malposition of anatomically normal bone is corrected by osteotomy and repositioning. Anatomically abnormal bone is replaced with bone grafts. The use of rigid fixation techniques prevents the late skeletal relapse seen with previous techniques. In the established post-traumatic deformity, soft tissue distortion from contracted underlying scar tissue and adherence to bony depressions and defects is the limiting factor in restoring the pre-injury appearance.