Face Value and Craniosynostosis

Face Value is a craniofacial surgery research programme led by top craniofacial surgeons Mr David Dunaway and Mr Owase Jeelani at Great Ormond Street Hospital (GOSH). Together, they are aiming to revolutionise surgery for children with craniosynostosis. At birth, a baby’s skull is made up of bony plates separated by seams known as sutures. The sutures are there to help with the moulding of a baby’s head during delivery, and play a role in shaping the head as it grows.

These sutures eventually fuse, forming a protective ‘helmet’ for the brain – otherwise known as the skull.

With craniosynostosis, a single suture or a number of sutures fuse much too early – even weeks or months before a baby is born. This can seriously restrict the growth and development of the brain, as well as the shape of the child’s head.

Children with craniosynostosis are likely to need a series of operations to help improve both the medical and cosmetic aspects of their condition.

One of the procedures these children will face is a process called ‘distraction’ which involves moving forward the head and face. It is achieved with a special operation called a monobloc osteotomy in which the fused bones in the skull and face are separated.

Following surgery, a semi circular ‘halo’ called a RED frame – a type of ‘distractor’ – is fitted to the child’s head. The frame is attached to the skull with metal pins and, over a period of around three months, the frame is gradually adjusted to help move forward the separated bones.

A monobloc osteotomy is an effective way of improving both the deformity and the related functional problems but the process is far from perfect. The treatment doesn’t fully correct the facial deformity and the RED frame is an incredibly cumbersome device that doesn’t produce entirely predictable results.

Despite the world-class expertise of our Craniofacial team, complications associated with the technique remain relatively common due to the shortcomings of the procedure. To address this problem, surgeons at GOSH have pioneered a new technique over the last few years using small stainless steel springs. Their technique is already dramatically improving the outlook for children with craniosysnostosis.

But further improvements in treatment, and making the innovations available to children all over the world, are only possible with investment in research and development.