WCF CRANIOFACIAL SURGERIES FACTSHEET
Three members of the World Craniofacial Foundation medical team, Dr Kenneth Salyer, Dr
Derek Bruce, scrub nurse Jennifer Diaz worked alongside Professor Frank Graewe, head of
the Division of Plastic and Reconstructive Surgery, University of Stellenbosch, Tygerberg
Academic Hospital, to assist two patients from outside South Africa in need of life-saving
craniofacial surgery.
1.
Who are the patients?
Patient 1: Grace, a seven-year-old girl from Zambia who suffers from a serious bony skull
defect. Grace previously had surgery in Mexico City but soon developed an infection and
complications resulting in about sixty percent of her skull needing to be reconstructed. The
surgical team had never before seen such a massive skull defect in a child that needed to be
managed with biomaterial.
Patient 2: Akikere, a six-year-old from Nigeria, suffers from Crouzon syndrome, a genetic
disorder characterized by the premature fusion of certain cranial sutures of the skull bones
and cranial base. The surgery was necessary to improve an upper airway respiratory
obstruction and to relieve intracranial pressure and reshape her skull.
2.
When and where were the surgeries performed?
Grace’s surgery took place on May 12, 2015 and took the team about four and a half hours
to complete. The surgery took place at Tygerberg Academic Hospital. Akikire’s surgery took
place on the May 14, 2015 and lasted six and a half hours. It took place at Tygerberg
Academic Hospital as well.
3.
Who were the surgical teams?
Plastic surgeons responsible for conducting all reconstructive work as well as loosening and
repositioning of the mid face:
Professor Frank Graewe, the Head of the Plastic and Reconstructive Surgery Division
at Stellenbosch University as well as the Head of the Craniofacial Unit at Tygerberg
Academic Hospital and the micro-surgeon involved in the ground-breaking penile transplant
that took place in December 2014. Professor Graewe has been a member of international
advisory committee of the WCF for many years and has cooperated with the foundation on
many occasions.
Dr Kenneth Salyer, is the Founder and Chairman of the World Craniofacial Foundation and is
internationally recognized as a pioneer and leader in craniofacial surgery. In 1989, he
established the World Craniofacial Foundation to treat children who had nowhere else to
turn. To date, Dr Salyer has served more than 13,000 patients from every state in the United
States and more than 75 countries around the world.
Neurosurgeons responsible for the elevation of the skull bone and the dissection of the
bone from the brain:
Professor Bennie Hartzenberg, the Chief Neurosurgeon at Tygerberg Academic Hospital and
Associate Professor in Neurosurgery at Stellenbosch University.
Dr Derek Bruce, practices neurosurgery in Washington, District of Columbia. He is one of the
pioneers of modern pediatric neurosurgery. His specialties include cranial base surgery,
craniofacial anomalies, epilepsy, and brain tumors.
4.
What would have happened if the surgeries did not take place?
Grace would have had to wear a protective helmet all the time, and would never be allowed
to be unsupervised to prevent brain injuries and complications. Akikere had already
developed severe complications due to the respiratory obstruction and would have died
without the surgery.
5.
Will further surgeries need to take place?
Both patients are doing well and the surgeries have been considered a success, however
both patients will require further surgeries for refinement.
6.
What planning and preparation took place in order for these surgeries to take
place?
These surgeries took an immense amount of planning and communication on the part of
numerous medical teams on three continents. In Grace’s case, her skull defect was so
severe that she was admitted to Tygerberg hospital six weeks before the surgery in order to
get a full craniofacial work-up completed.
7.
What were the challenges for these surgeries?
In Grace’s case, there was not enough of the patients own bone to reconstruct the skull and
therefore the team needed to find an alternative option for reconstruction. With the
previous history of infection, as well as the increased risk of infection due to the amount of
biomaterial, this surgery was particularly challenging. Grace’s surgery is categorised as
ground-breaking due to the extent of the defect and the use of different materials and
growth factors in combination.
In Akikere’s case, the respiratory obstruction due to the severe mid-face deformity from
Crouzon syndrome lead to right-side heart failure. This resulted in massive challenges for
the anaesthetists and surgeons as the surgery could not take place with lowered blood
pressure due to the heart condition and this and excessive bleeding needed to be managed
carefully.
8.
What are the scientific names for these surgeries?
Grace: Massive skull bone reconstruction and cranioplasty with “bone engineering” a
prefabricated restorable mesh framework, demineralised bone and bone morphogenic
protein.
Akikere: Monobloc advancement with osteadistraction (distraction of mid-face and
forehead as a unit). This means that the whole face and forehead is surgically loosened
from the skull and slowly advanced forward on a daily basis with specially designed turning
devices.
9.
Who is available for interviews?
Professor Frank Graewe, the lead South African Surgeon is available for all interviews.
Dr Kenneth Salyer is available for telephonic, skype and email interviews.
Dr Derek Bruce is available for telephonic, skype and email interviews.
Akikere and her mother are still in SA and are available for interviews.