Facial Trauma and Reconstructive Surgery

Facial Trauma and Reconstructive Surgery

Our surgeons have extensive experience managing patients with severe maxillofacial and head and neck injuries. As members of Legacy Emanuel Hospital’s Level 1 Trauma Team, our surgeons are uniquely qualified to help patients with facial injuries as well as the cosmetic and functional deformities that sometimes result from serious facial trauma. Trained as medical doctors as well as dentists, our physicians are experts at reconstructing the face and jaws from both a cosmetic and functional standpoint.

The list to the right is an abridged list of the most common facial trauma and reconstructive surgery related topics managed by the highly trained, diverse group of specialists at HNSA. It is for patient information only and is not meant to be all-inclusive.

“I originally picked Dr. Bryan Bell because of his credentials—my insurance company required me to see a medical doctor/dental surgeon for my first procedure. I continued to see Dr. Bell for the last 10 years because he is not only a skilled, knowledgeable surgeon, but also a compassionate and caring man who was concerned about me as a person, not just as a patient. Dr. Bell is positive and upbeat even in the face of dire circumstances, and always makes me feel hopeful. I have never felt rushed or like he didn’t have time for my questions. He is very thoughtful and even took the time to meet with my children to talk to them about the upcoming surgery and what they could expect me to look/sound like. Dr. Bell never gave up, even when the odds were stacked against me. I always tell people they can expect the best care from Dr. Bell because he is the best!” – Rebecca Roth

Reconstructive Surgery Using Flaps

Our surgeons are internationally renowned experts in complex facial reconstruction. Through the use of 3-D Virtual Surgical Planning, we’re able to accurately restore facial form and function, while taking into account speech, swallowing and dentition.

A “flap” is tissue with its own blood supply that is borrowed from another part of the body. Our surgeons can then use this tissue to reconstruct defects of both bone and soft tissue. A “free flap” is a flap that is harvested from a distant sight, such as the forearm or leg. The arteries and veins that accompany the flap are connected to blood vessels in the neck using high magnification surgical microscopes and thin sutures. By using tissue with its own blood supply, our surgeons are able to import healthy tissue to unhealthy areas. Flaps have very high rates of success and typically heal better than grafts.

Cleft/Craniofacial Surgery

As medical doctors and dentists, our surgeons are uniquely qualified to provide the most effective and comprehensive care for patients born with cleft lip/palate. Clefting is a variation of nature, and we believe that parental education and support is a critical element in the overall successful management of a cleft child. We’re invested in helping pregnant parents become fully informed and prepared, so that they can have the confidence that their newborn will be properly cared for by our highly skilled surgeons.

Additionally, our surgeons provide craniofacial surgery to treat congenital and acquired deformities of the craniofacial skeleton and soft tissues. As a surgical team, we examine patients and discuss treatment plans weekly, allowing our patients to see most, or all related specialists in a single visit.

Randall Children’s Hospital Cleft/Craniofacial Team

Founded in 1993 by Dr. Dierks and partner as the Emanuel Hospital Cleft Craniofacial team, the Randall Children’s Hospital Cleft/Craniofacial Team draws together a group of dedicated, highly trained professionals. For patients born with cleft lip or other craniofacial abnormalities, we’ve found that treatment is best managed through a multidisciplinary team. We work together to manage surgery, speech pathology, orthodontics, pediatric dentistry, genetics, occupational therapy and developmental pediatrics—all in one location.

Alveolar Cleft Repair with Bone Grafting

In children with cleft lip and palate, there is often a defect, which includes the soft tissue of the lip and nose, the gums, bone of the upper jaw and nasal base, and the hard and soft tissues of the palate. Typically, the soft tissues of the lip and palate are repaired during the first year of life in order to facilitate eating and normal speech development. Closure of the gum defect of the upper jaw and bone grafting are delayed until the child is about 9-11 years old.

In coordination with an orthodontist, our surgeons perform an operation where the nose and mouth are sealed off from each other by rearranging the existing gum tissue. In between those layers, bone graft, typically harvested from the hip, is used to rebuild the bone of the nasal base and upper jaw in order to make the upper arch continuous. This procedure offers the best chance of normal eruption of adult teeth, and also provides the opportunity to place implants later on in the event of missing teeth.

Distraction Osteogenesis

A technique used to lengthen the jaws, distraction osteogenesis is primarily performed on children, or when the degree of shortening is severe. Unlike standard orthognathic jaw surgery, distraction osteogenesis lengthens the jaw slowly over time, allowing the skin and other soft tissues to lengthen along with it.

During the first operation, the jaw is first exposed and then the surgeon performs a controlled split of the jaw, applying the distraction device. Part of the device, the activation arm, is left exposed, either into the mouth or through the skin. There is a delay before the lengthening starts, called the latency period. Following the latency period, our surgeon will then instruct the patient on how often to activate the distractor. With each activation, the device stretches the bone and soft tissue a small amount, ranging from 1-2 mm a day. Once the desired lengthening has occurred, the activation arm is removed, leaving the distractor in place. In the final operation, the surgeon removes the distractor.