USE OF MODERN CRANIOFACIAL TECHNIQUES FOR COMPREHENSIVE RECONSTRUCTION OF THE ACROMEGALIC FACE

The severe acromegalic patient poses a difficult reconstructive dilemm a to the craniofacial surgeon. Significant facial deformities can incl ude frontal bossing, prominent supraorbital ridges, malar flatness, ma xillary hypoplasia, mandibular prognathism with class III malocclusion , and macrogenia. Reports on the correction of these deformities are r are. Prior publications describe long hospital stays, weeks of interma xillary fixation, requirement for a tracheostomy, as well as the need for multiple, staged procedures and interdisciplinary teams. In an eff ort to extend the advances of modern craniofacial techniques to this g roup of patients, we performed an extensive reconstruction on a 28-yea r-old acromegalic patient using a one-stage procedure without the use of intermaxillary fixation and without the added morbidity of a trache ostomy. The procedure addressed the skeletal deformities of the upper face, the midface, and the lower face. The operation was performed by a single plastic surgery team and the patient was extubated in 36 hour s and discharged in 6 days. We believe that the use of rigid fixation and the judicious application of modern craniofacial principles can al low a complex yet safe one-stage procedure to reconstruct the acromega lic face. Such an approach showed decreased perioperative morbidity an d provided an excellent functional and aesthetic result.