Craniofacial Surgery: The Long and Winding Road

For nearly half-a-century, the reconstruction of children with craniofacial deformities has relied primarily on two dimensional photographic images and radiographs.  It was the surgeon’s eye and experience that integrated the two dimensional records to generate the virtual three dimensional image for surgical planning.  In the last decade of the twentieth century, multidimensional visualization of the skeletal deformity became possible with the emergence of computerized tomography.  This allowed the surgeon to visualize the complexity of the deformity but not the ability to simulate surgery.  Within the last several years, computational software began to transform the pure visual imagery of CT to allow surgical simulation to become a reality.  In addition, the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) now allows engineering and manufacturing technology that is specific for the patient.  Today’s surgeons are beginning to have the tools to accurately simulate the surgical procedure ex vivo, optimizing facial form and functional outcomes before entering the operating theater.  This revolution in technology and in the development of the virtual operating theater has enormous impact not only for patients, but also for the training of the next generation of surgeons.