How surgery for head and face deformities (craniofacial reconstruction) is done depends on the type and severity of deformity, and the patient's condition.
Surgical repairs involve the skull (cranium), brain, nerves, eyes, facial bones, and facial skin. That is why sometimes a plastic surgeon (for skin and face) and a neurosurgeon (brain and nerves) work together. Head and neck surgeons also perform craniofacial reconstruction operations.
The surgery is done while you are deep asleep and pain-free (under general anesthesia). The surgery may may take 4 to 12 hours or more. Some of the bones of the face are cut and moved. During the surgery, tissues are moved and blood vessels and nerves are reconnected using microscopic surgery techniques.
Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in spaces where bones of the face and head were moved. Small metal screws and plates may be used to hold the bones in place. The jaws may be wired together to hold the new bone positions in place. To cover the holes, flaps may be taken from the hand, buttocks, chest wall, or thigh.
Sometimes the surgery can cause a lot of swelling of the face, mouth, or neck, which may last for weeks. This can block the airway. You may need to have a temporary tracheotomy. A small hole is made in the neck, through which a tube (endotracheal tube) is placed in the airway (trachea). This allows you to breathe the face and upper airway are swollen.