Complex Craniofacial Surgery Normalizes Appearance of Patient with Crouzon Syndrome
Matthew Roche, 22, was born with Crouzon syndrome, a rare genetic disorder that is characterized by an abnormal fusion of the growth plates of the skull. This disorder also prevents the maxilla, cheekbones and eye sockets from growing as much as the rest of the face. 
“Because Matthew’s cheekbones did not grow properly, his eyes had the appearance of being bulgy or ‘bug-eyed.’ In addition, the failure of his upper jaw to grow caused severe malocclusion,” explains Albert Woo, MD, chief of pediatric plastic surgery and director of the Cleft Palate and Craniofacial Institute at St. Louis Children’s Hospital. “Our goal was to normalize his appearance so that he would feel more comfortable among his peers
and in society at large.”
Dr. Woo’s surgical plan was to pull Matthew’s whole face forward by rebuilding much of his face and skull. The procedure was technically complex by itself, but additional factors made it even more challenging.
“Matthew had undergone previous procedures by other surgeons, the most recent of which was 10 years ago,” says Dr. Woo. “Not only did he have a lot of scar tissue, but he also had multiple metal plates inside his face. Over the years, those plates had imbedded themselves into his bone.”
Matthew underwent a procedure referred to as a LeFort III advancement. In it, Matthew's upper facial bones are completely separated from the rest of his craniofacial skeleton. These bones are then moved forward to improve projection to the eyes and improve dental occlusion. In Matthew's case, he was advanced approximately 15mm. The intervening gaps in the bone where the advancement was performed were filled in with bone grafts harvested from the outer layer of the skull.
“The surgery allowed us to pull Matthew’s face forward a little more than half an inch. Now his teeth are in proper alignment and the bottom of his eyes are resting in the proper position above his cheekbones,” says Dr. Woo. “This is one of the most complicated surgeries we as plastic surgeons can perform for an individual, and Matthew came through with flying colors.”
According to Laura Roche, Matthew’s mother, his life had been on hold before his surgery at St. Louis Children’s Hospital. “I’m just amazed knowing how much Matthew has been through and seeing how much confidence he has gained,” she says.
Matthew’s newfound confidence is one of the best rewards for Dr. Woo as a craniofacial surgeon. “It is gratifying to improve someone’s appearance and function so dramatically with one procedure that it changes that person's perception of self as well as the way other people perceive that person. Patients like Matthew are the reason that I love my job,” says Dr. Woo.
To contact Dr. Woo or for a patient referral, call Children’s Direct at 800.678.HELP (4357).
