SYM3 The history of craniofacial surgery in Japan, with long term results.

Abstract

Introduction: Japan is one of the Far East countries that others find “mysterious”. For those of us who live there, it is anything but; however, there are many unique aspects of Japan that can be recognized, including some medical ones. Methods: On average, there are many important, well-known physical characteristics of those of East-Asian descent which should be taken into consideration during surgery, such as poor skin extensibility, slow blood coagulation, and ease of infection. Another point of Japanese craniofacial surgery, medical care has been conducted under the National Medical System with almost no financial burden, especially medical expenses for every children who receive surgical treatment, are covered fully by government budget. Therefore, patients have been given necessary and appropriate examinations and hospitalization thanks to the lack of financial burden on the management of craniofacial surgery. Therefore, we have obtained vast amounts of clinical data, especially image data such as CT and X-P. Additionally, unique techniques and research related to craniofacial surgery have been developed due to Japanese faculty of medicine emphasizing repetition, meticulousness, and dexterity. Furthermore, Japan has developed some of the world’s best medical technology, based on the transfer of craniofacial technology to Japan from the West for the past 50 years. Results: Regarding cranial expansion specifically, frontal cranial distraction techniques invented in Japan and fronto-orbital advancement/reshaping based on normal (average) Japanese individual’s data of supra-orbital region and intracranial volume, have been performed for more than 20 years. So far, 263 patients with craniosynostosis have undergone fronto-orbital advancement and cranial remodeling in our institute. 75 of 122 patients assisted by frontal cranial distraction have been followed up with, after removal of devices, providing CT data and photos for 10 to 22 years, and also 57 of 141 patients who underwent surgery with traditional methods have been followed up with postoperatively, providing more than 20 years of CT data and photos. Conclusions: In conclusion, the history of highly-developed Japanese craniofacial surgery is well-documented and fairly extensive, benefiting from the support of the children care system covering some costly procedures (3D-solid model, expensive surgical devices and et.al.). Taking a closer look at some of the details can be quite interesting and educational. I will present the history of craniofacial procedures unique to Japan, with a focus on cranial expansion, and also the Japanese medical system affecting surgical policy, including the period of admission and cost.