Correction of the skeletal deformity in these children commonly improves the appearance of the face. However some cases will have deficiency of the soft tissues and correction of the bony deformity alone is not sufficient to correct the facial contours.
There are a number of options to address this problem but they are generally delayed until after skeletal surgery. There are occasions where soft tissue augmentation needs to be considered earlier. For example in a severe Pruzansky III where there is almost no soft tissue below the skin (eg, no masticatory muscles, no parotid gland etz.).
2. Augmentation options
The choice of augmentation procedures depends very much on the precise nature of the deformity, its precise location and the wishes of the surgeon and patient. The options are:
Augmentation of facial contours with dermis fat grafts and/or fat injections
Augmentation of facial contours with soft tissue vascularized flaps eg, parascapular, latissimus dorsi, various perforator flaps, etc.
3. General wound care
Apply ice packs (may be effective in a short term to minimize edema).
The sterile dressing placed over the incisions is maintained for a minimum of 48 hours. Thereafter routine wound care should be instituted.
Antibiotic prophylaxis is continued for 1-5 days depending on the nature, complexity, and duration of the surgical procedure.
Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used.
Regular follow up examinations to monitor healing are required.
Avoid sun exposure and tanning to skin incisions for several months.