The History of Craniofacial Surgery

Craniofacial surgery encompasses a broad spectrum of reconstructive procedures of the cranium and face. The objective of these procedures is to correct deformities of the face and skull bones that result from birth defects, trauma, or tumors. The specialized field of craniofacial surgery has made tremendous advancements in the treatment of major facial deformities over the past twenty-five years. This type of surgery was officially initiated at the 4th Congress of the International Confederation for Plastic and Reconstructive Surgery in Rome, 1967.

The pioneer and originator of this remarkable field of surgery is Dr. Paul Tessier, a French plastic surgeon. It was Tessier who renewed the interest of plastic surgeons around the world in innovative operative procedures for the treatment of severe congenital facial deformities. Prior to Dr. Tessier's revolutionary impact on facial reconstructive surgery, contributions were made by other men in the field of maxillofacial surgery that have served as starting points.

Rene LeFort, another Frenchman, in 1901 published three consecutive papers on the now famous classification of facial fractures. His work described the lines of weakness in the face through which most fractures occur. These lines, where the facial bones break in trauma, have become known as the LeFort I, II, and III fractures. This work served as the stepping stone for the development of maxillofacial surgery. In addition, these fracture lines have also served as a guide for facial osteotomies used to correct post-traumatic and congenital facial anomalies. However, it was a number of years before LeFort's work made an impact on clinical practice.

World War II produced a number of major facial deformities and stimulated the further development of facial reconstructive surgery. Sir Harold Gillies, an English plastic surgeon, was a leading contributor in the reconstructive techniques of traumatic deformities. Gilles further advanced this field by applying his experience to the treatment of major congenital anomalies. In 1949 Gillies performed the first LeFort III osteotomy which is a separation of the facial bones from the skull with movement of the upper jaw forward. This was the first attempt to drastically correct congenital facial deformities with bony facial surgery. Gillies was apparently unhappy with the result due to relapse and never performed the procedure again.

In 1967, Tessier presented the successful case in which a facial advancement was performed to treat a patient with Crouzon's. A LeFort III osteotomy and advancement was designed to include a major portion of the orbits with the upper jaw. This generated great interest in the new and radical type of surgery. His procedures violated the current surgical standards of the day; however, he proved that such radical techniques enabled correction of severe congenital deformities. His technique of dissecting soft tissue from the facial bones with simultaneous intracranial exposure and circumferential mobilization of the orbits enabled drastic repositioning of the eyes and the skull. Tessier's techniques are based on the principle that the bones must be repositioned or reconstructed before the soft tissue can be repaired. Subsequent growth of this specialty was very rapid. Surgeons from the United States and all over the world visited Tessier to learn these new operative procedures. As a result of the surgeons he taught, Craniofacial Centers emerged in the U.S. Along with this came the multi-disciplinary team approach to provide consistency and safety with the most advanced treatment for patients suffering from facial anomalies.

Dr. Tessier has remained the leader in this specialty for the past thirty years. His innovative techniques and contributions are too numerous to list. As he enters retirement, this specialty continues to grow rapidly due to contributions from craniofacial surgeons around the world. This ensures that craniofacial surgery will continue to offer new hope and promise to patients with facial deformities.