Craniomaxillofacial surgery involves surgery of the cranium and facial skeleton and is based upon principles of understanding the important relationship between the underlying bone and the overlying soft tissue.
Its origins are relatively recent but like many things in Plastic and Reconstructive Surgery, come from the necessity to deal with devastating ballistic injuries occurring during the conflicts of the First and Second World Wars. Craniofacial surgical techniques have been developed to manage the problems of facial trauma, tumor surgery and the management of congenital pediatric craniofacial conditions. Sophisticated CT and MRI radiologic imaging and an intimate understanding of the anatomy of the craniofacial skeleton have allowed surgeons to manipulate and repair the craniofacial skeleton in precise and predictable ways. One of the biggest advances in this field came about through the development of small titanium and bioresorbable plates and screws that can be used to rigidly fix and maintain the 3-dimensional shape of the bones of the craniofacial skeleton. This technique of rigid internal fixation can be used to restore the normal framework of the face and speed a faster recovery following surgery.
The Division of Plastic, Reconstructive & Aesthetic Surgery is very active in Craniomaxillofacial Surgery and boasts some of its alumni as pioneers in this field. Dr. Ian Munro was the first pediatric craniofacial surgeon in the country and started to develop this specialty at the Hospital for Sick Children in the 1970’s after spending time in Paris learning techniques from the master, Dr. Paul Tessier. Craniomaxillofacial trauma surgery was developed at Sunnybrook Health Science Centre by Dr. Joe Gruss who applied rigid internal fixation techniques to repair facial fractures and invented innovative techniques in primary bone grafting.
Today, the University of Toronto Division of Plastic, Reconstructive & Aesthetic Surgery has a Pediatric Program in Craniomaxillofacial Surgery at the Hospital for Sick Children under the supervision of Dr. John H. Phillips, Division Chief working with Dr. Christopher R. Forrest, Dr. Johanna Riesel, and Dr. Dale Podolsky.
Sunnybrook Health Science Centre is a level one trauma unit and boasts an active adult craniomaxillofacial surgery program which is managed by Dr. Oleh Antonyshyn and Dr. Jeff Fialkov.
St. Michael’s Hospital is also a level one trauma unit and manages craniofacial trauma for the downtown core and also from peripheral hospital within and outside of the Greater Toronto Area. Dr. Karen Cross, Dr. Melinda Musgrave, and Dr. Blake Murphy all participate in the care of patients with craniofacial injuries.
Fellowships in both pediatric and adult craniomaxillofacial surgery are available at the Hospital for Sick Children and at Sunnybrook Health Science Centre.