Difficult questions facing the craniofacial team.

Children born with growth problems that affect the cranium or face require an initial correct diagnosis and appropriate specialty referral. Craniofacial surgery is a necessary and effective specialty that involves a multifaceted approach to the treatment of children with abnormal growth, deficient development, or traumatic or postnatal damage to the cranium and face. There are many unanswered questions concerning the treatment of these children that require ethical as well as scientific reflection by all involved in their care. Disagreements exist among the teams regarding both the timing of surgery and the best operative procedure. Reported mortality rates are 1-3% and all centers should have their own mortality and morbidity figures available for potential patients. Surgical interventions for craniosynostosis-regardless of whether it is isolated or syndromic-should not be undertaken lightly. These are major operations in infants and children. A complete multi-speciality team is necessary for comprehensive care of the children and their families. Which aspect of therapy; surgical, psychological, educational, speech or motor development is responsible for maximizing functional outcome for these children remains unclear and thus all possible services should be available.