21175 Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

Name of the Procedure:

Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (e.g., plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

Summary

This reconstructive surgery involves reshaping and adjusting the frontal and upper orbital areas of the skull, typically to correct congenital abnormalities such as misshapen skulls (e.g., plagiocephaly, trigonocephaly, or brachycephaly). The surgery may involve the use of grafts, which can be taken from the patient’s own body.

Purpose

The procedure addresses congenital skull abnormalities that affect the shape of the head and face. The goals include improving head shape for cosmetic and functional reasons, such as relieving brain pressure or allowing for normal brain growth.

Indications

• Congenital skull deformities such as plagiocephaly (flat head syndrome), trigonocephaly (triangular head), or brachycephaly (short head)
• Visible asymmetry or deformity of the forehead and orbital rims
• Symptoms such as developmental delays due to restricted brain growth

Preparation

• Fasting typically required the night before the surgery.
• Medication adjustments as advised by the healthcare provider.
• Preoperative imaging studies like CT or MRI scans for surgical planning.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incisions: Surgical incisions are made in the scalp to access the skull.
3. Bone Reshaping: The surgeon carefully removes, reshapes, and repositions parts of the frontal bone and orbital rims.
4. Grafts: If needed, bone grafts are taken from other parts of the patient's body and used to support reconstruction.
5. Reconstruction: The bones are fixed in their new positions with plates, screws, or other surgical hardware.
6. Closure: The incisions are closed with sutures or staples, and a bandage is applied.

Duration

The procedure typically takes 4 to 8 hours, depending on the complexity.

Setting

The surgery is performed in a hospital operating room under sterile conditions.

Personnel

• Pediatric or craniofacial surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Common: Bleeding, infection, swelling, bruising
• Rare: Nerve damage, adverse reactions to anesthesia, long-term asymmetry, or need for further surgery

Benefits

• Improved head shape and facial symmetry
• Potential relief from symptoms caused by pressure on the brain
• Enhanced cosmetic appearance and self-esteem

Recovery

• Hospital stay for a few days post-surgery for monitoring.
• Pain management with medications.
• Avoid strenuous activities for several weeks.
• Follow-up appointments to monitor healing and progress.
• Swelling and bruising will gradually diminish over several weeks.

Alternatives

• Non-surgical interventions such as molding helmets (effective only in early infancy)
• Less invasive surgical techniques, depending on the severity and specific condition.
• Pros: Non-surgical options like helmets are less risky and involve no recovery time.
• Cons: They are only effective during specific early developmental windows and may not fully correct severe deformities.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel anything. Post-operatively, some pain, swelling, and discomfort are expected, but these can be managed with medications. Most patients experience significant improvements in head shape and facial symmetry within a few months.