Combating Constraints of the Functional Matrix: The Importance of Overcorrection in Pediatric Craniofacial Surgery

Abstract

Background: To effectively manipulate the bone, particularly in the growing patient, the craniofacial surgeon must understand the principles related to bone-based reconstruction. A theory of craniofacial growth that is both biologically accurate and clinically relevant is thus needed. Methods: A historical review of major findings across various disciplines (including orthopedic surgery, anatomy, embryology, orthodontics, and cell biology) will be covered, as it pertains to the concept of the functional matrix of the craniofacial skeleton. Results: The functional matrix dictates the interplay between the soft tissue envelope and bone grafts, thus guiding donor site choice and inset methods. The soft tissue may also warrant the use of bony hypercorrection especially in cranial vault remodeling. Control of both bone and boundaries of the soft tissue functional matrix can be achieved via distraction osteogenesis. Conclusion: The soft tissue functional matrix must be accounted for during craniofacial bone grafting, mobilizing osteotomies, and distraction osteogenesis if optimal aesthetic results are to be obtained using the least amount of procedures.

Craniofacial Soft-Tissue Anthropomorphic Database with Magnetic Resonance Imaging and Unbiased Diffeomorphic Registration

“…of procedures performed, and rapid craniofacial growth. 3 Current popular methods of assessing postoperative results are subjective or demonstrate poor interrater reliability, even among experts. [4][5][6] Perhaps the most popular and widely adopted system for appraising postoperative craniofacial surgery outcomes is the Whitaker classification system, which assigns a score ranging from 1 to 4 based on the magnitude of subsequent surgery required to achieve aesthetic "normalcy."…”

“…1,2 In the pediatric population, assessing short- and long-term postoperative outcomes may prove particularly challenging because of the complexity of patient presentations, diversity of procedures performed, and rapid craniofacial growth. 3…”