Reviving the Past, Moving on to the Present, and Planning for the Future of Craniofacial Malformations

The malformed newborn with craniofacial anomalies was variously regarded in different civilizations. Some populations considered it a symbol of the presence of God, whereas others brutally eliminated it. Understanding of craniofacial malformations started in the 19th century, with the development of embryological, experimental studies. Management of congenital facial deformities was not mentioned in medical literature until the middle of the 14th century. Ambroise Paré (1510–1590), published the first image of a cleft lip closure in 1561. Priority for cleft palate suture is shared between the German Carl Ferdinand von Gräfe (1787–1840) in 1817 and the Frenchman Philibert Joseph Roux (1780–1854) in 1819. Other examples of correction of congenital facial defects were reported by Jacques M. Delpech (1772–1832), who treated a naso-ocular cleft in 1828, and by John Collins Warren (1778–1856) at Massachussest General Hospital in Boston, who excised a large facial haemangioma, using ether for the first time. The patient had no pain during the whole procedure and the date of October 16, 1846 is best remembered as Ether Day or Death of Pain, opening a new era for modern surgery. Repair of major craniofacial anomalies represents one of the major achievements of plastic surgery of the last decades. In 1967, Paul Tessier (1918–2008), first demonstrated the importance of intracranial access as the sole solution to correct hypertelorism, approximating the abnormally distant orbits along the midline. Tessier also conceived an anatomical classification of craniofacial malformations based on a detailed numbering system. New innovations and technologies are rapidly enriching our practices. Distraction osteogenesis (DO) plays a key role in the surgical correction of malformations of the craniofacial skeleton. Virtual surgical planning (VSP) has transformed the way craniomaxillofacial surgeries are planned and executed. Artificial intelligence (AI) represents a completely new field. It will revolutionize craniofacial surgery in the near future.