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Craniofacial Surgery: Open Cranial Vault Reconstruction

At Mobile Oral and Facial Surgery, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help. 

Fast Facts About Craniofacial Surgery 

  • Craniofacial surgery is an operation to fix congenital defects of the skull, meaning problems that were present at birth, or injuries to the soft tissue and bone in the head and neck. 
  • Your childs craniofacial surgery will be done under general anesthesia, which means that he or she will be sound asleep during the surgery. 
  • When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. 
  • This surgery usually takes about 8 hours, depending on the type and severity of your child’s reconstruction. 
  • Your child will stay in the hospital for at least 3 days after the surgery. 

What Is Craniofacial Surgery? 

Craniofacial surgery is a type of plastic surgery that deals with the correction and reconstruction of malformations or problems of the skull. One of the most common conditions treated with craniofacial surgery is craniosynostosis (CRAY-nee-oh-SIN-oh-STO-sis), the early closing of the spaces between the bones of the skull, resulting in abnormal skull growth. The particular surgery to correct craniosynostosis is called a cranial vault remodeling. 

A plan for craniofacial surgery may be put in place as early as 4 months of age, or as soon as the problem is recognized. Patients who are referred to the Cleft-Craniofacial Center at Childrens Hospital first receive a physical exam, followed by CT scans to confirm the diagnosis. An eye exam by a pediatric ophthalmologist (eye surgeon) should follow, in addition to a consultation with a pediatric neurosurgeon (brain surgeon). This team of doctors, along with the craniofacial surgeon, will map out the plan for your childs reconstructive craniofacial surgery. 

Before the Surgery 

Several weeks before surgery you will meet again with your surgeon for a preoperative history and physical and to discuss the surgery. Other scans may be ordered in order for the team to do what is called a Virtual Planning, which will help the surgeon determine the best plan for your childs surgery. 

Home Preparation on the Day of Surgery 

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse from the preoperative department. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions. 

  • The nurse will give you specific eating and drinking instructions for your child based on your childs age. Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse. 

For children older than 12 months: 

  • After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, and chewing gum or candy. 

For infants under 12 months: 

  • Up to 6 hours before the scheduled arrival time, formula-fed babies may be given formula. 
  • Up to 4 hours before the scheduled arrival time, breastfed babies may nurse. 

For all children: 

  • Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid® and juices you can see through, such as apple or white grape juice. 
  • In the 2 hours before the scheduled arrival time, give nothing to eat or drink. 
  • You may bring along a comfortitem –  such as a favorite stuffed animal or blankie–  for your child to hold during the surgery. 
  • You should bring a long-sleeve Tshirt, slightly larger than your childs usual size, to the hospital on the day of surgery. It will help make your child more comfortable on the day you take your child home from the hospital. 

Day of Surgery 

Your child will come to their scheduled hospital the morning of the surgery. When you have checked in, you and your child will be called to an examination room where your childs health history will be taken, and vital signs will be checked. 

You will meet with one of the doctors on your childs surgical team to go over the surgery. He or she will answer any last-minute questions you might have at this time. A member of the anesthesia staff also will meet with you and your child to review his or her medical information and decide which kind of sleep medication he or she should get. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given. 

When it is time for your child to go the operating room, you will be asked to wait in the surgical family waiting area. 

  • If your child is very scared or upset, the doctor may give a special medication to help him or her relax. This medication is flavored and takes effect in 1O to 15 minutes. 
  • If relaxation medicine is needed, you may stay with your child as he or she becomes drowsy; you will be asked to wait in the surgical waiting area when your child is ready to move to the operating room. 
  • Young children get their sleep medication through a space maskthat will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake. 
  • Once your child is asleep, an intravenous or IV line will be inserted into a vein in your childs hand or arm so that medication can be given to keep him or her sleeping throughout the surgery. Your child will have no pain during the surgery and no memory of it afterward. 

To complete the craniofacial surgery, the surgeon will shave your childs head , this allows him to make an incision or cut in your childs scalp to get to the skull bones. This incision will run from ear to ear, not to worry though, your child’s hair will grow and over time the scar will not be visible. 

Your child will have sutures or stitches in his or her scalp to close the incision. All the sutures will be dissolvable, meaning that they will not need to be removed. As the skin heals, the parts of the sutures that are under the skin will dissolve on their own and will be absorbed into the skin. Any part of the suture that you can see on the top of the skins surface will dry up and fall off. 

A Parent’s/Guardian’s Role 

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm. 

During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times, in case the family needs to be reached. 

While Asleep 

While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. To keep your child asleep during the surgery, he or she may be given anesthesia medication by mask, through the IV or both. When the surgery is over, the medications will be stopped, and your child will begin to wake up. 

Waking Up 

When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up. 

  • Your child will need to stay in the recovery room to be watched until he or she is alert and vital signs are stable. The length of time your child will spend in the recovery room will vary because some children take longer than others to wake up after anesthesia. 
  • Your child will still have the IV in. A nurse will remove it before your child leaves the hospital, when he or she is drinking well. 
  • Children coming out of anesthesia may react in different ways. Your child may cry, be fussy or confused, feel sick to his or her stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off. 
  • Your child will have a gauze dressing wrapped around his or her entire head like a helmet. 
  • Your childs face will be swollen and his or her eyes might be swollen shut. Although it is hard for parents to see their childs face so swollen, this swelling is completely normal and is not painful. Sometimes, the swelling gets worse on the second or third day after surgery. By the time your child returns for his or her first post-surgical follow-up visit, usually 1 week after surgery, much of the swelling will have gone down. 
  • Your child can be given pain medication every 4 to 6 hours, as needed, when he or she wakes up. 
  • When your child is alert, he or she will be moved to the Pediatric Intensive Care Unit (PICU) for the first night, so the nursing staff can monitor his or her condition closely. He or she will be moved to a regular hospital room when the doctor feels your child is ready, usually sometime the next day after surgery. 
  • When your child is drinking well and urinating normally, the IV will be removed by a nurse. 


Going Home 

  • Your child will stay in the hospital until the doctor feels he or she is ready to go home, which usually is about 3 to 4 days after surgery. 
  • When your child is discharged from the hospital, the gauze dressing “helmet” will be removed. A nurse 
  • will give you instructions on cleaning the scar, which usually is just light soap and water, followed by a coating of bacitracin antibiotic ointment. No additional dressings are needed. 
  • If you must travel for more than 2 hours to the follow-up visits and need overnight accommodations, 
  • please ask to speak with a clinical social worker who will help make those arrangements.