Craniofacial Surgery for Craniosynostosis: Challenges in Diagnosis, Management and Long-term Outcome
Chaiwit Thanapaisal MD*, Bowornsilp Chowchuen MD MBA**, Prathana Chowchuen MD***
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand *** Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background and Objective : Craniofacial surgery for craniosynostosis is one of the most challenging recon-
structive procedures. Restoration of particular functional and anatomic requirements is important for devel-
opment from infancy to adulthood. The purpose of this study is to present the authors’ experience of craniofa-
cial surgery for management of patients with craniosynostosis in Srinagarind Hospital, Khon Kaen, Thailand,
addressing the challenges of diagnosis, management and outcomes, which may be adapted in other develop-
ing countries.
Material and Method: This paper presents the cranial and associated deformities, diagnosis, radiologic
findings, preoperative evaluation, craniofacial and maxillary surgeries and outcome(s) of patients with
craniosynostosis. The care team, made up of neurosurgeons, plastic surgeons, radiologists, ophthalmologists
and pediatricians, established the Tawanchai Center’ s protocol for craniosynostosis, to manage the timing of
craniofacial procedures from infancy to adulthood.
Results : The physical examination and radiologic findings of three patients, two with sagittal synostosis and
one with plagiocephaly are reported. The clinical, craniofacial and maxillofacial surgeries and long-term
outcomes of another three patients were studied, one with Apert syndrome and two with Crouzon syndrome.
All the latter three patients were lost to follow-up after the initial post-surgical visit. At that time, there were
appropriate surgical results vis-à-vis appearance and satisfaction from the perspective of the two patients
with Crouzon syndrome and their families. One of the patients with Crouzon syndrome received normal
education supported by a successful family, while the other was still continuing her studies at school with
good progress. The patient with Apert syndrome continued to live with his parents. Additional reconstructive
surgery is recommended for all three patients. Economic problems and lack of adequate information were the
main reasons for their discontinuing follow-up appointments.
Discussion and
Conclusion : Systematic physical examination and radiologic assessments by the craniofacial
team are critically important for diagnosis, evaluation, planning of management and outcome assessment of
the patients with craniosynostosis. In Thailand and other developing countries, the challenges in manage-
ment of these patients are the development of standard craniofacial surgery, craniofacial team management
and well-coordinated care, planned surgeries and outcome assessments from infancy to adolescence. A sup-
portive government health system and establishment of a craniofacial center and foundation is needed in
order to support and provide proper care for these groups of patients.
Keywords : Craniosynostosis, Craniofacial surgery, Challenges, Diagnosis, Team management, Long-term outcome, Developing countries
