A surgery that requires a combined effort

bangalore: they call themselves neuro plastica and offer expertise in a very specialised area of medicine -- cranio-facial surgery. available in very few centres across the country, it involves the work of a plastic surgeon, neurosurgeon, neuroradiologist, ophthalmologist, ent surgeon, anaethesiologist, speech therapist, geneticist, neuropsychologist and dental surgeon.at the forefront of the team are plastic surgeons niranjan kumar and y.n. anantheshwar and neurosurgeon dr sujay rao, all consultants at manipal hospital here. cranio-facial surgery is a vital area as many patients with such deformities have been, and still are being labelled mentally retarded on the basis of appearance, which is not true. explains dr anantheshwar, ``there is an abnormal fusion of skull bones prematurely leading to these monstrous deformities. the exact cause is still a mystery. however, detailed psychological testing of the child should be done pre-operatively.'' says dr rao, ``cranio-facial surgery is a new speciality designed originally for major congenital bone deformities of the skull. the techniques of extensive skeletal exposure and direct fixation of mobilised segments or reconstruction of absent areas of bone by skill and rib grafts can also be applied to trauma involving the cranio-facial skeleton.'' cranio-facial deformity is caused by underlying bone defect. correction involves either repositioning or construction with autogenous bone grafts. explains dr niranjan kumar, ``extensive areas of cranio-facial skeleton can be dissected, repositioned and still survive. they could be moved permanently in any of the three planes without affecting vision by careful circumferential mobilisation of orbital contents.'' the doctors believe that a cranio-facial procedure should never be considered routine because of the risks involved. the major risks are brain damage, vision impairment and infection. however, in the hands of an experienced team, this is rare. the timing of such surgery is very important. says dr anantheshwar, ``all premature fusion of skull bones should be done under the age of one year. encephaloceles should be treated as early as possible. orbital hypertelorism is best treated around two years of age. treacher collins syndrome should be treated around the age of five for eyeball correction and around 16 years for jaw correction. hemifacial microsomia is tackled around the age of nine years.'' it is also important to ready the patient psychologically before taking him on for any procedure. ``the greatest psychiatric danger lies in an unrealistic expectation from the correction and a failure to understand the possible risks involved,'' cautions dr rao.