|Year : 2022 | Volume
| Issue : 5 | Page : 3
Ajay Sinha1, Deepak Gupta2, Suhas Udayakumaran3
1 Alder Hey Childrens’ NHS Foundation Trust, Liverpool, UK
2 All India Institute of Medical Sciences, New Delhi, India
3 Division of Paediatric Neurosurgery and Craniofacial Surgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
|Date of Submission||13-Apr-2022|
|Date of Acceptance||13-Apr-2022|
|Date of Web Publication||19-Sep-2022|
Dr. Ajay Sinha
Department of Paediatric Neuroscience, Alder Hey Children’s NHS Foundation Trust, Liverpool
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sinha A, Gupta D, Udayakumaran S. Guest Editorial. J Pediatr Neurosci 2022;17, Suppl S1:3
Craniosynostosis is a congenital disorder of premature fusion of one or more of the 6 skull sutures.
Skull deformity either congenital or acquired has been known to mankind since ancient times. The Egyptian and the native American Indians were familiar with the impact of chronic external forces on skull deformity as evident in various paintings and sculptures from that time period.
Modern craniofacial surgery started in the 1890 by Lannelongue who released the sagittal suture in a case of scaphocephaly. Lane followed it 2 years in 1892 with a similar synostectomy.
However, in 1894, Jacobi showed an exceptionally high mortality rate in the earlier procedures- 15 death out of 33 operated cases by doing a meticulous audit of the surgical series. The initial high mortality would be explained by poor selection of cases and late surgery. A number of microcephalics were operated under the mistaken notion of craniosynostosis and this led to the high operative mortality. Incidentally Jacobi who was a paediatrician serendipitously laid the foundation stone of modern clinical audit and taught surgeons the most important lesson; to record of their surgical outcome.
Since then there has been tremendous forward movement in the development of craniofacial surgery. The pioneering work of Paul Tessier in the middle half of twentieth century and his close collaboration with his neurosurgery colleague Gerard Guiot led to the development of a combined midface and transcranial extradural approach for correction of a severe case of telorbitism. The former presented his work at the International meeting of plastic surgery in Rome in the year 1967. Thus began the modern era of craniofacial surgery.
This close collaboration between a plastic surgeon and a neurosurgeon has been the cornerstone of modern craniofacial surgery. Since then this model has been replicated and expanded and refined across various prominent craniofacial units around the World. The contributions of allied surgical specialities like Ophthalmology, ENT, Orthodontics and Hand surgery and non- surgical disciplines like clinical genetics, clinical psychology, respiratory, Speech and language therapy, specialist nursing support and service coordinators have led to a truly comprehensive care of this complex group of patients.
In our experience vast majority of non- syndromic cases do not need follow up past 15 years of age. However, a subset of syndromic craniosynostosis and a tiny number of non- syndromic cases need to be followed up lot longer for ongoing concerns a need to be transitioned to adult services. This has led to an organic development of an adult cranial reconstruction service in our practice. The skill set available in the service also provides specialist input to a group of non craniosynostotic adult patients with complex skull defects with or without associated soft tissue deficits.
This issue addresses some of the challenges and controversies in craniofacial surgery. Special emphasis has been paid to include discussions on newer techniques like endoscopic surgery, distraction procedures and advances in midface surgery.
I join my co- editors Prof. Deepak Gupta and Prof. Suhas Udayakumaran in acknowledging the help and support of Prof Dattatraya Muzumdar and for giving us the opportunity to guest edit the special issue on craniofacial surgery of the Journal of Pediatric Neurosciences.
This issue will become a ready reference to various experts and senior trainees working in this field of surgery.