Early History of Cleft and Palate Surgery
Congenital clefts of the lip and palate produce structural facial changes that, while significant, generally do not make an affected person an outcast from society and work. More than a century ago, surgeons started developing techniques to close clefts of the lip and palate, giving patients a better quality of life and improved speech.

Dozens of surgical procedures, many emerging in the last 50 years, promote a more normal facial appearance and profile, dental pattern and quality production of speech.

Breakthroughs in Major Craniofacial Surgery
While people have been born throughout the centuries with complex structural skull and facial problems, treatments for children born with major noncleft craniofacial birth defects have emerged more recently than those for cleft conditions. Major craniofacial conditions may involve:

• Skull/face asymmetry
• Absence or undergrowth of a facial structure
• Disproportion of facial components such as the jaw
• Clefts of the face beyond the lip or palate
• Abnormal position of eyes or ears
• Severely distorted skull shapes
• Abnormal patterns of face/skull growth in childhood

During the 20th century's wars, military plastic surgeons developed many techniques to help re-create the faces of severely wounded soldiers. However, even with the availability of some of these techniques, few surgical attempts were made to create a more normal face for children with congenital facial defects such as Apert Syndrome and Hemifacial Microsomia. Many of these children were shunned and became social outcasts, and some were even placed into institutions for the mentally challenged.

In the 1960s, the French plastic surgeon Paul Tessier attempted surgical procedures on a few of these severely affected patients. He challenged long-held medical beliefs and developed radically new approaches to the treatment of major craniofacial birth defects that went beyond standard surgical techniques. He believed the underlying bony defect in major craniofacial deformities had to be repositioned or reconstructed. From this concept, he developed three surgical techniques previously considered impossible:

• Large areas of the skull can be cut away from the rest of the head, devascularized (separated from their original blood supply), repositioned elsewhere on the skull or face and revascularized — all with the patient surviving. This permitted the remodeling of major skull and facial deformities.
• Surgery on the bony eye sockets can allow permanent relocation of the eyes without affecting vision.
• Simultaneous surgery, both within the cranial cavity and outside the skull, can radically reposition or reconstruct the bony eye sockets and skull.

Dr. Tessier’s dramatic, successful surgical treatment of several craniofacial patients attracted much attention from the international medical community. A small group of other plastic surgeons adapted his techniques and began treating children with severe craniofacial birth defects.

Dr. Tessier recognized early on that this type of revolutionary surgery was so specialized and complex that it should be performed only by surgeons who could work within a matrix of medical and dental professionals representing a variety of disciplines. Such a team could provide the specialized treatment and care needed by the craniofacially deformed child.

Origins of Medical City Children’s Hospital Craniofacial Center
In the late 1960s, several plastic surgeons in North America began to dedicate their work entirely to the care of craniofacial birth defects and trauma. New insights and surgical techniques were rapidly developed and popularized. Children with major facial birth defects finally had champions to help them live more normal lives.

Two of the pioneers in craniofacial surgery were Dr. Kenneth E. Salyer and Dr. Ian Munro. Dr. Salyer, who continues to work in Dallas, brought craniofacial surgery to the southwestern United States. Dr. Munro, who is now retired, blazed a similar trail in Canada. In the early 1980s, Medical City’s leadership invited both surgeons to develop a world-class craniofacial surgical institute in Dallas. The hospital provided the two surgeons with a professional multidisciplinary staff and modern facilities, enabling them to treat hundreds of patients each year. In 1986, the Dallas Craniofacial Center—later renamed the Medical City Children’s Hospital Craniofacial Center—began operation.

Building on the foundation created by Dr. Salyer and Dr. Munro, the Center’s multidisciplinary team has emerged at the forefront of advances in craniofacial surgical techniques. The center has treated thousands of patients from every U.S. state and more than 75 other countries, performing more than 15,000 surgical procedures to make children’s craniofacial features more normal. And each year, our world-renowned team of surgeons and medical specialists performs thousands more, helping children better face the world.