About the Craniofacial Centre

Craniofacial conditions can be divided into three groups: facial and craniofacial malformations, facial fractures and craniofacial tumours. The Craniofacial Centre brings together the expertise in the different types of craniofacial conditions. Craniofacial surgery is interdisciplinary. This means that several different specialists work together in treatment teams. Craniofacial surgery is often performed jointly by surgeons from different specialities, such as plastic surgery, neurosurgery and oral surgery. The Centre was established with the aim of creating the best possible conditions for interdisciplinary patient care.

The Craniofacial Centre provides National Highly Specialised Care (NHV) for children with craniofacial malformations and is a member of a European Reference Network (ERN) for rare craniofacial diagnoses.

The Centre's quality management system has been certified according to ISO 9001 and SS-EN 15224 since 2016. Se verifikat på svenska (pdf). (See the certificate in Swedish)

Contact us

Responsible Head Physician: Daniel Nowinski, switchboard 018-611 00 00.

Referral for craniosynostosis

Referral information for mail:

Akademiska sjukhuset 
Plastikkirurgmottagningen 
Attn: Kraniofacialt centrum 
751 85 Uppsala

E-referrals can also be submitted via plastikportalen, allowing you to securely upload patient images and records. For scheduled care, patients are initially scheduled for a consultation.

Contact details

Responsible Head Physician: Daniel Nowinski, switchboard 018-611 00 00.

Contact nurse for craniosynostosis: Anna Stenson Zerpe, 018-611 94 66.

Referral to cleft lip and palate (CLP)

Referral information for mail:

Akademiska sjukhuset 
Plastikkirurgmottagningen 
Attn: Kraniofacialt centrum 
751 85 Uppsala

Internal referrals in Cosmic are made to "Plastikkirurgi".

Contact details

Responsible Head Physician: Malin Hakelius, switchboard 018-611 00 00

Contact nurse: 018-611 93 74

The CLP team

We are a team of specialists who treat children with cleft lip and palate (CLP). Treatment is similar across the country and follows a specifically developed care programme. The CLP team consists of plastic surgeons, orthodontists, phoniatrists and speech therapists specialising in the treatment of children with cleft lip, palate and other craniofacial disorders. This allows the CLP team to provide qualified full treatment. For children with special needs, the team has access to all the other expertise that may be required for treatment.

• Plastic surgeon: plastic surgeon with specialised training in CLP.
• Orthodontist: dentist specialising in orthodontics and occlusal development.
• Phoniatrists: ear physician specialising in voice, speech and language.
• Speech and language therapist: Specialised in CLP, assesses speech and language development and treats speech disorders.
• CLP nurse: contact person/coordinator for newborn visits and CLP conferences
• Surgical coordinator: nurse who schedules and gives notification for surgery
• Children's group: staff with paediatric training. Participate in newborn visits and care for babies on the ward

The CLP team participates in the national CLP register. Several clinical research projects are ongoing.

Referrals to facial trauma 

The primary care of patients with facial injuries must follow ATLS principles. The referral pattern is then dictated by the type of injury, the presence of other trauma and the patient's place of residence. Continuing care is coordinated within the facial trauma team.

24-hour contact for facial trauma is accessed via the primary resident for plastic surgery or oral surgery. In cases of neurotrauma, the neurosurgery on-call team should be contacted first.

Special considerations for the primary care of patients with facial trauma:

• Ensure a clear airway. NOTE foreign bodies and teeth in the airway.
• Treat acute bleeding in the nose and mouth.
• Rule out traumatic brain and neck injuries (according to ATLS).
• Is there evidence of retrobulbar haematoma or other acute eye injury or disability?
• Open fractures should be closed.
• Computed tomography (CT) with close axial slices from skull to chin tip for complete diagnosis of skeletal injuries in all regions of the face.

Indications for emergency or urgent surgery for facial fractures:

• In some cases, frontal fractures are treated urgently if there is a neurosurgical indication for emergency surgery. Examples include evacuation of intracranial haematomas or open fractures with communication to the intracranial space.
• Orbital compartment syndrome due to retrobulbar haematoma or blow-in fracture.
• Incarceration of extraocular muscles with a risk of muscle ischaemia and permanent muscle damage.
• Treatment of soft tissue or facial nerve injuries.

The team

The activities for the treatment of facial trauma are primarily run by the specialities of plastic surgery, oral surgery and the Division of Ear, Nose and Throat Diseases. Plastic surgery and oral surgery have been combined into a single organisational area. In addition, multidisciplinary care involves close collaboration with neurosurgery, anaesthesia, ophthalmology and radiology and, when necessary, with other trauma surgical specialties within the Trauma Theme.

The facial trauma team also treats patients with secondary residual conditions after facial trauma who were previously treated primarily at Uppsala University Hospital or other hospitals. Examples include post-traumatic enophthalmos, post-traumatic nasal deformity, malocclusion.

Treatment

The aim of treatment is to restore the shape and function of the face as far as possible and to prevent post-traumatic deformities and residual conditions. The timing of surgery is dictated by the nature of the injury, other injuries and any co-morbidities. As a rule, facial fractures should be operated on within two weeks, scheduled and during the day. Patients with traumatic brain injury are operated on after initial neurological recovery and when intracranial pressure is stable.  See below for indications for emergency/semi-emergency action.

Good planning is key to the successful treatment of patients with facial trauma. The skeletal injuries of all patients are assessed at the multidisciplinary dental and radiology review meeting. If necessary, operations are planned using software programmes that allow for the separation of the different bones of the face and three-dimensional models. When necessary intraoperative navigation, patient-specific implants and intraoperative computed tomography are used to increase precision.  

The composition of the surgical team for an individual patient is determined by the type of injury. As a rule, mandibular fractures are operated on by oral surgeons, while plastic surgeons are responsible for frontal and orbital fractures. Midface fractures are operated on jointly by plastic and oral surgeons. Neurosurgeons participate in all operations involving a transcranial component and all patients with traumatic brain injury are cared for at the Neurointensive Care Unit (NIVA). Closed nasal reduction of isolated nasal fractures is performed in the Ear, nose and throat department.  The rhinology team participates in co-operative surgeries for complex nasal and NOE fractures.

Follow-up

The follow-up of patients is dictated by the type of injury and the surgical treatment performed. Follow-up takes place at the local hospital and at Uppsala University Hospital. Visits to Uppsala University Hospital are carried out as co-assessments with involved specialities if possible. Follow-up takes into account post-operative healing and recovery, restoration of facial shape and function as well as further measures for any residual conditions.

Referral to other craniofacial surgery

Referral information for mail:

Akademiska sjukhuset 
Plastikkirurgmottagningen 
Att: Kraniofacialt centrum 
75 185 Uppsala

Internal referrals in Cosmic are made to "Plastic Surgery".