San Diego ­ Yesterday, the distinguished craniofacial surgeon, Milton T. Edgerton, M.D., presented the ASMS Kazanjian Lecture, "Early U.S. Efforts at Craniofacial Surgery: A Personal Historical Perspective."

He spoke of his own personal experiences over the years in craniofacial reconstruction, particularly his work with children ­ and, in the process, he traced the way knowledge is passed among surgeons, as techniques steadily improve. At times, information is passed in less conventional ways. Dr. Edgerton described an experience in 1952, a year after being given a full-time teaching position at Johns Hopkins University .

"A shipment came from the Belgian Congo, and inside, packed in dry ice, was the head of the chief of a Bantu tribe," he said, adding that the chief had frontal deformities and the head had been sent for Dr. Edgerton to study.

He spoke of other surgeons, particularly Paul Tessier of France. His contributions to the field, as well as Dr. Edgerton's and others, helped further the field and the outcomes of patients. Outcomes are also determined by the psychological state of patients and Dr. Edgerton stressed the importance of treating children with craniofacial deformities early in life. He said this lessens the stress of the family and the child, who will not have memories of the original deformity.

Dr. Edgerton also spoke of the current state of craniofacial surgery. "Operations have become more sophisticated with better results. Younger and younger children are being operated on, so they don't need to grow up and go to school with these deformities."

He added that there are challenges that lie ahead in getting treatment for all those who need it. "One problem relates to medical economics. Almost all these children have normal brains and if they get the surgery, they can live as normal people and have normal lives. But this surgery is big. And insurance companies are slow to cover it. Certainly it's not experimental anymore. But children are dependent upon charities because health insurance companies tend to deny anything they think they can. It's profit motive."

Dr. Persing, once a student of Dr. Edgerton, said that while reconstruction first fueled cosmetic developments, today the cosmetic and reconstructive branches of plastic surgery readily cross-pollinate. "They feed back into one another in a kind of cross talk," he said, adding that the work surgeons on the cosmetic side have done with soft tissue has taken reconstructive surgery to a higher place. As Dr. Edgerton put it, "Advancements in craniofacial surgery have added real fizz in that champagne called plastic surgery."