Craniosynostosis Surgery: the Legacy of Paul Tessier

Neurosurg Focus 36 (4):E17, 2014 ©AANS, 2014

Craniosynostosis surgery: the legacy of Paul Tessier

Historical vignette

*Michael G. Z. Ghali, Ph.D.,1 Visish M. Srinivasan, M.D.,2 Andrew Jea, M.D.,2 and Sandi Lam, M.D.2 1Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania; and 2Department of Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas

Paul Louis Tessier is recognized as the father of craniofacial surgery. While his story and pivotal contributions to the development of the multidisciplinary practice of craniofacial surgery are much highlighted in plastic surgery literature, they are seldom directly discussed in the context of neurosurgeons. His life and legacy to craniosynostosis and neurosurgery are explored in the present paper. (http://thejns.org/doi/abs/10.3171/2014.2.FOCUS13562)

Key Words • Paul Tessier • craniofacial surgery • craniosynostosis • history

he history of craniosynostosis surgery is an inter- disorders that are the consequence of premature fusion of esting one and has been well discussed in the re- one or more cranial sutures. In a majority of cases, cra- cent neurosurgical literature.30 However, operative niosynostotic disease involving a single suture is not asso- interventionT for craniosynostosis is not a field exclusive ciated with medical or neurological complications,2,18 and to neurosurgeons, with one of the most important contrib- in these cases surgery is indicated primarily for cosmetic utors to the development of modern techniques hailing purposes. With multiple suture involvement, complications from the field of plastic surgery—Paul Louis Tessier (Au- including, but not limited to, brain growth restriction, hy- gust 1, 1917–June 6, 2008). To fully appreciate the his- drocephalus, and blindness constitute medical indications tory and evolution of craniosynostosis surgery, one must for surgery, in addition to aesthetic restoration. Early op- understand both Tessier’s direct contributions to this con- erative intervention (in patients prior to 6 months of age) dition proper as well as his indirect contributions through has been reported to achieve good results1,6,8,9,12,19,29,40 but the development of operative strategies employed gener- is associated with an increased incidence of reoperation. ally in the correction of craniofacial deformities. What Conversely, late operative intervention less frequently re- we now consider to be the “routine treatment” of cranio- quires reoperation and enables intraoperative correction, synostosis and other craniofacial pathologies is based in but often involves more extensive reconstruction. the many principles and methods pioneered by Tessier. Craniosynostosis is most frequently nonsyndromic To date, Tessier’s impact on neurosurgery from his work and monosutural but may be associated with a known ge- on craniosynostosis and facial trauma has not been dis- 30 netic disorder, such as Crouzon or Apert syndrome. The cussed. In fact, multiple disciplines, including plastic latter may involve multiple synostoses and often require surgery, head and neck surgery, oral-maxillofacial sur- more extensive and staged reconstruction. Nasal and oral gery, ophthalmology, and neurosurgery, have been deeply airway functions are often affected in these cases. influenced by Paul Tessier’s work. Simple synostectomy was first performed by Lan- nelongue (1890)23 and Lane (1892).22 In many patients, the Background operation was performed late and resulted in consider- able reossification, which led to reestablishment of brain Craniosynostosis constitutes a heterogeneous group of growth restriction. Moreover, in an early case series of 33 patients, Jacobi (1894)20 reported a high operative mortal- Abbreviation used in this paper: CFD = craniofacial dysostosis. ity rate (15 deaths). The high failure rate and mortality * Drs. Ghali and Srinivasan contributed equally to this work. burden in these early cases had two possible antecedents:

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1) microcephaly was misdiagnosed as craniosynostosis or 2) the surgery was performed late; they were possibly less associated with a high surgical risk itself.7,8 These early surgical techniques were less than ideal, rarely achieving a satisfactory cosmetic outcome in patients with craniosynostosis. More severely affected patients, such as those with craniofacial dysostosis (CFD), were simply left un- treated, being deemed “inoperable.”

Early Life and Training Paul Tessier was born in 1917 to Ernest and Solange Tessier, who hailed from a line of wine merchants in a small town, Héric, near Nantes, France. Originally, Tes- sier aspired to work in forestry or join the navy but was prevented by poor health. Perhaps spurred by his moth- er’s battle with tuberculosis, he instead pursued a career in medicine. He attended medical school in Nantes27 from 1936 to 1943. During the German occupation of France in World War II, his training was interrupted by military service. In 1941, he was taken as a prisoner of war.41 A year later, his professor in infectious diseases found him to be critically ill with typhoid myocarditis and con- vinced his captors to release him. He returned to Nantes and finished medical school, only for his hometown to be destroyed in a bombing raid the following year. He ven- tured north, to Paris, to continue his surgical residency and pursue his newfound interest in cleft palate and plastic surgery (Figs. 1 and 2).21,43

Early Career His first appointment in Paris was with Maurice Vi- renique, a maxillofacial surgeon. They worked together Fig. 1. Photograph of Paul Louis Auguste Ernest Tessier (August at the Red Cross military hospital and moved to Hôpi- 1, 1917–June 6, 2008). Reproduced with permission from A Man from tal Foch,21 where Tessier gained tremendous experience Héric: The Life and Work of Paul Tessier, MD, Father of Craniofacial in treating facial injuries at the Maxillofacial and Burn Surgery. Figure 17.2. Copyright S. Anthony Wolfe. Photo taken by Jim Center. Then he moved to the pediatric surgery service Fletcher, ca. 1975. at Hôpital St. Joseph and worked with George Huc (a prominent orthopedist); he gained exposure to plastic Tessier was influenced greatly by his own unique set surgery and orthopedics. When Virenique died, Tessier of multidisciplinary training and by individual mentors was named chief of plastic surgery at Hôpital Foch. By who were giants in each of those fields. In his inaugural this time, he had garnered experiences in general surgery, address to the International Society of Craniofacial Sur- pediatric orthopedics, and otorhinolaryngology.43 Still, he gery in 1985, he credited his training (and collaborators) sought to enhance his training further. in pediatric orthopedics (G. Huc),43 facial trauma (M. Vi- Between 1946 and 1950, he made frequent trips to renique), facial reconstruction (H. Gillies, A. McIndoe), the United Kingdom, for 1–2 months at a time, to observe ophthalmology (G. Sourdille, P. Francois), cleft palate clinical practice and techniques of the surgical masters surgery (P. Petit), and neurosurgery (G. Guiot, J. Roug- who practiced there.21,43 He sought out Sir Harold Gillies, erie). 24 This wide range of training was not set up for Tes- an otolaryngologist based in London, who is arguably sier in any formal manner—he sought it out.43 considered the father of plastic surgery. Gillies performed After Tessier began to establish himself on the na- the first maxillary osteotomies on a patient with Crouzon tional level as a master of craniofacial pathology, he was syndrome,11 one of the congenital facial syndromes that consulted in 1957 about a patient with facial deformity would later become the cornerstone of Tessier’s career.25 of an extreme nature—a young man with Crouzon syn- During his many visits, he observed, performed surgery, drome, presenting with severe facial retrusion. The opera- took copious notes, and developed a strong basis in the tion he sought to perform had been previously tried by his fundamentals of craniofacial surgery. At that time, rapid mentor Gillies, who had undertaken the first Le Fort III advances in plastic surgery were occurring in response to osteotomy in 1950 to correct the same deformity. How- severe wartime injuries. Tessier described his experiences ever, the newly positioned bone relapsed, and Gillies did with plastic surgery pioneers Sir Harold Gillies and Sir not attempt the surgery again. Gillies commented “never Archibald McIndoe as “a revelation.”21 to do it”11,21,25,44 and had deemed the condition inoperable.

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of severe teleorbitism.25 After much deliberation, Tessier had determined that the only way to achieve sufficient correction would be through an intracranial frontal approach to the midface and interorbital region. Guiot, his feet up on his desk, looked up at the ceiling for a moment, then replied: “Pourquoi pas?” (Why not?) (personal communication, S. A. Wolfe, December, 31, 2013). This rhetorical question captured the spirit of Tessier’s innovative development of craniofacial surgery and later became the motto of the International Society of Craniofacial Surgery. This answer shattered the wall that existed between the cranial region and the face, and between neurosurgeons and plastic surgeons, and opened up the way for the development of a con- structive collaboration.25 Their boldness was complemented by thoroughness; prior to attempting the procedure, Tessier and Guiot planned every step, anticipated every potential complica- tion, and practiced on cadavers for well over a year.21,43 Fig. 2. Photograph of Tessier and his wife Mireille at the Lido, 1971. Together, they achieved a result that would have had been Reproduced with permission from A Man from Héric: The Life and Work 43 of Paul Tessier, MD, Father of Craniofacial Surgery. Figure 15.1. Copy- impossible in any other hands. Between this case and right S. Anthony Wolfe. others, over the next several years, they developed a technique for an intracranial extradural dissection of the re- Tessier suspected that the application of multiple autog- gion, up to the optic canals, and used a dermal graft for enous bone grafts would make the repositioned construct dural reinforcement.31,36 more stable. For over 3 years, Tessier and Guiot worked to hone Tessier wished to study on cadaver skulls and mas- their technique and improve the cosmetic/aesthetic out- ter the cranial and facial anatomy prior to attempting come for their patients, who had been given no chance any intervention.44 Parisian medical schools denied him previously. In 1967, their new techniques were showcased access to an anatomy room in the city as he had not at- at the International Meeting of Plastic Surgery in Rome. tended school there. Thus, he and his loyal scrub nurse Tessier’s presentation was extremely well received, and Micheline Huguenin43 would take the train to Nantes, 500 thus the field of craniofacial surgery was recognized. miles away, to practice the operation in the anatomy lab While Guiot is mentioned in the plastic surgery liter- at his old medical school. They would return to Paris on ature for his famous quote, “Pourquoi pas?”, many of his the 2:30 am train and be at work a few hours later.21 The contributions to the technique that he developed alongside preparatory work proved worthwhile. Tessier achieved a Tessier are not always highlighted. The trio of Tessier, successful result with his novel surgery,43 advancing his Guiot, and Jacques Rougerie published their extensive ex- patient’s face by 25 mm. Because of a historic dispute at perience in the French- and English-language literature, his hospital,45 Tessier did not have access to splints, which describing their technical advancements in transcranial were thought to be necessary for stabilizing the facial approaches for facial malformations and solutions to the skeleton;21 Tessier’s method obviated the need for such al- challenges associated with this approach. Subsequently, loplastic materials such as silicone and acrylic implants. the younger Patrick Derome joined the group and became In addition to working with cadaver skulls with nor- Tessier’s primary neurosurgical collaborator.5,37 Derome mal anatomy, Tessier realized that he needed to study ab- and Rougerie continued to work very closely with Tessier, normal skulls to fully understand and visualize the neces- as his practice transitioned away from Hôpital Foch and sary corrections. He continued his search for the perfect to Clinique Belvedere (personal communication, S. A. anatomical specimen for study and operative preparation Wolfe, December, 31, 2013), while Guiot stayed at Foch throughout his career,36 which also sparked his later foray and continued pursuing his broad interests in skull base, into 3D image reconstruction and radiology.17 pituitary, stereotactic, and functional neurosurgery. Guiot It seemed he had the perfect constellation of training and Tessier coauthored 6 papers together, of which 4 were to be able to teach himself about craniofacial deformi- craniofacial related and 2 were skull base related. It is ties and their treatment.27 He became familiar with intra- likely because of his intimate knowledge of the skull base cranial and extracranial approaches for these syndromes; anatomy and technique that he was able to collaborate however it was not until he found a team of enthusiastic so well with Tessier on innovative craniofacial surgery. collaborators at Hôpital Foch that he saw a turnaround in Tessier made the development of craniofacial surgery his his outcomes. full-time passion and career, while Guiot continued pur- In 1963, Tessier approached Gérard Guiot, a young suing the rest of neurosurgery, in addition to operating neurosurgeon working at the same Hôpital Foch, in Paris. with Tessier in craniofacial procedures. Guiot continued Guiot and Tessier had collaborated previously on recon- writing prolifically in neurosurgery, mainly about pitu- struction of the orbital roof following resection of sphe- itary33 and movement disorder surgery,15 until the early noid ridge meningiomas.15,16,43 They had a famed meeting 1980s, ultimately retiring with nearly 300 publications. when Tessier was developing an approach for correction In 1969, Tessier and Guiot co-chaired a symposium

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Unauthenticated | Downloaded 10/06/21 06:02 AM UTC M. G. Z. Ghali et al. at Hôpital Foch on various topics in craniofacial surgery. niques in conjunction with combined extracranial and in- This was a joint venture describing their work over the tracranial approaches permitted surgical procedures that preceding 6 years, covering neurosurgical interests (for were not previously possible. example, encephaloceles, anterior skull base tumors, CSF Tessier emphasized the importance of being able to leak repair, and craniotomy approach for hypertelorism) harvest autogenous bone grafts, such as those from the and plastic surgical ones (for example, craniofacial oste- rib, iliac crest, or calvaria. As an example, calvarial auto- otomies, facial dysmorphia, posttraumatic deformities, grafting has proven to be an instrumental technique, with and orbitocranial trauma).43 At the meeting, to which 60 a plethora of applications, in craniofacial reconstructive ophthalmologists, plastic surgeons, maxillofacial sur- surgery. In general, the calvarial autograft is harvested. geons, and neurosurgeons were personally invited, there The use of inner table calvaria results in better preserva- were live surgical demonstrations, critiques, and lively tion of skull contour. Thus, in the case of a concurrent discussions. craniotomy, the inner table is harvested ex vivo and the Tessier was interested in breaking barriers among remaining outer table replaced and secured using wires specialties throughout his career, and frequently invited or, later, miniplates.4,10 pediatricians, radiologists, plastic surgeons, maxillofacial Tessier was not only conversant with bone graft har- surgeons, and neurosurgeons to his courses and sympo- vesting: He also developed an array of instruments to sia36 (Fig. 3). He traveled frequently to nurture these rela- bend and shape bone grafts into any form and shape (Fig. tionships, to large centers in the United States, England, 4). His use of autogenous bone grafts to prevent relapse and around France. His urge to contribute was based in associated with precise osteotomies has tremendously en- his philosophy that “no one man could master all tech- hanced the durability of reconstructions.28 He originally niques and be an island unto himself.”34 It is widely rec- used bone grafts to treat a patient with midfacial retru- ognized that most craniofacial surgeons in the US are sion45 but also successfully applied the same technique deeply influenced, either directly or indirectly, by Tessier in frontonasal and frontal encephalocele and in cases of and can trace their educational lineage back to Tessier in cleft lip with communication of the orbit, maxilla, and some form.21,42 oral cavity, among many others.28 The combination of During the late 1960s and the 1970s, Tessier de- extracranial and intracranial approaches in the same veloped the procedures and foundations of craniofacial procedure proved instrumental in many of the surgical surgery: transcranial and subcranial correction of orbital improvements credited to him and has greatly improved dystopias such as orbital hypertelorism, correction of the the treatment of craniosynostosis. Tessier strived for cra- facial deformity of CFD (for example, Treacher Collins– niofacial surgeons to “feel just as comfortable with bone Franceschetti syndrome, Crouzon syndrome, and Apert as we are with soft tissue.”42 syndrome), and correction of oro-ocular clefts. Crouzon and Apert Syndromes Advancements in Working With Bone Tessier is best known for his work on CFD, specifi- In applying to the facial skeleton standard orthopedic cally Crouzon and Apert syndromes. The techniques he principles—osteotomies, bone grafting, and direct cor- developed for treating CFD were then applied to many rection of deformities—Tessier revolutionized craniofa- other pathologies in the world of plastic and reconstruc- cial surgery as it is practiced today. The use of these tech- tive surgery, such as restorations after trauma or tumor resection.35 Prior to Tessier, the treatment of craniosynostosis, es- pecially the syndromic variety, was largely rudimentary and there remained much room for improvement. This created the perfect niche for Tessier after the comple- tion of his training. As described earlier, older children with craniosynostotic disease may need more extensive craniofacial reconstruction, and Tessier’s contributions have mainly improved the management of complicated forms of the disease, including those in patients exhibit- ing multiple suture involvement and in patients with CFD. Whereas contemporaries sought to achieve a near-normal appearance, Tessier more significantly underscored the importance of the aesthetic outcome and always aimed to achieve normality. Historically, the treatment of the craniosynostotic disease proper in CFD was still associated with facial deformities. Consequently, Tessier emphasized the need Fig. 3. A typical Tessier consultation, circa 1980, at UCLA. Present are plastic surgeons, oral surgeons, orthodontists, ophthalmologists, for an optimal cosmetic outcome and, to this end, in- and neurosurgeons. Tessier always emphasized the importance of troduced advancement of the forehead and supraorbital incorporating various disciplines in his discussions of craniofacial sur- rim.26 Originally developed as a more extensive coronal gery. Reproduced with permission. Copyright S. Anthony Wolfe. synostectomy, Tessier further modified the procedure by

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Fig. 4. A small selection of tools designed by Tessier, including a heavy mallet (A); special osteotomes (B–E) for harvesting cranial bone; periosteal elevators (F and G); scalp clamps (H and I); scalp hemostat (J); a T.O.M. (Tessier osteo-microtome) (K); bone bending forceps (L); bone cutter (M); and bone clamps (N). Reproduced with permission from A Man from Héric: The Life and Work of Paul Tessier, MD, Father of Craniofacial Surgery. Figure 27.1. Copyright S. Anthony Wolfe. fixing the forehead only to the face and not the remainder entire middle third of the face, with cuts of the zygoma of the posteriorly related calvaria. This permits cranial and orbits along with interpterygomaxillary disjunction. vault expansion and brain growth to advance the fore- Osteotomies of the ethmoid, posterior maxilla, and vomer head, achieving a more optimal cosmetic outcome. are also performed. He inserted bone grafts into the zygo- Tessier carefully studied timing of surgeries and matic/malar step cuts, the frontomalar gap, and glabellar identified that the growth of the midface, orbits, and ante- area, with reattachment of the middle third of the face. rior skull base were closely related.35 Specifically related This procedure achieves anterior translation of the face to neurosurgery and craniosynostosis, CFD presented and proper dental occlusion.35 extreme cases of faciosynostosis associated with brachy- He was unhappy with the results obtained with the Le cephaly or oxycephaly.38 Without the challenge of the hy- Fort III in Crouzon and Apert patients (namely, retrusive pertelorism associated with a severe case of Crouzon syn- foreheads and overly long noses). He instead preferred in- drome, Tessier may have never been “simply obliged”36 to tracranial monobloc procedures, since these resulted in collaborate with Guiot for their novel approach. normal faces in most cases.46 This represents the depar- Tessier’s solution for CFD, as described in his ini- ture from the limit of maxillofacial surgery (Le Fort III) tial 14 cases in 19673 and 35 more in 1971,35 was radi- and the foray into true craniofacial surgery.43 cal, yet based in well-established orthopedic principles In addition to the novel surgical principles, another he had learned from George Huc.43 In one paper, he even remarkable feature of Tessier’s publications was their makes a reference to “cranio-facial orthopedic surgery.”37 thoroughness—replete with preoperative and postopera- In short, it involved making osteotomies that would re- tive sketches and accompanied by plenty of patient pho- produce a facial disjunction, between the pterygoid and tographs35,37,38 (Fig. 5). He also included many recom- maxilla. He varied slightly the cuts that Gillies made in mendations on intraoperative planning and postoperative his failed operation,11 but the novelty of Tessier’s solution care. His training by world experts from a variety of dis- was the application of multiple bone grafts and postop- ciplines and his “team approach” philosophy allowed him erative fixation to allow stabilization.43 to get excellent exposure for his osteotomies from close The operative approach employs osteotomy of the collaborations with the Foch neurosurgeons—Guiot,

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Rougerie, and Derome.5,37 This, in addition to his many courses and live demonstrations in Paris in the years to come, allowed the widespread dissemination of the principles of craniofacial surgery.

Application of Craniofacial Surgery to Other Conditions Prior to Tessier, the core principle applied in the treatment of facial fractures was attachment to the nearest intact superior structure, with stabilization achieved by wiring. Tessier’s introduction of bone grafts to the treatment of facial fractures revolutionized the management of congenital and acquired craniofacial disorders alike and has impacted multiple related surgical subspecial- ties. His contributions to the treatment of facial fractures are many, and a comprehensive discussion is beyond the scope of this review. In brief, Tessier pioneered subperi- osteal dissection, which, by allowing direct interosseous osteosynthesis using wire and miniplates, obviated the need for external fixators. Improved primary stabilization also avoided the need for intermaxillary fixation and in turn tracheostomy. 42 Having an insightful understanding in ophthalmology, Tessier was able to make significant contributions to the treatment of orbital disease. He treated enophthalmos by reconstruction of the orbit and obturation of the in- ferior orbital fissure, and he was the first to pioneer use of a transcranial approach to correct global dystopias via orbital repositioning. Tessier also developed a transnasal approach to perform medial canthopexy in the treatment of posttraumatic telecanthus42 and was the first surgeon to place a bone graft in the orbital cavity.42,43 Lastly, Tes- sier is known to have been the first surgeon to spare the temporalis muscle and to use a more posteriorly placed coronal incision at the vertex rather than the anterior hairline, techniques that are currently common practice in neurological and craniofacial surgery (personal communication, S. A. Wolfe, December 8, 2013).

Legacy As the founding father of the specialty, Tessier’s personal approach to craniofacial surgery came to define the philosophy of a whole new generation of surgeons. He emphasized the importance of learning from each case, the work ethic required to succeed in solving the challenges of the field, and the importance of collaboration within the “craniofacial team.”24,32 This included physi- cians and nurses, as well as long-time scrub nurse Eliza- Fig. 5. Transcranial monobloc frontofacial advancement for treatment of Crouzon and Apert syndromes. This technique was developed beth Motel-Hecht, and served as a prime example of how by Tessier in the early 1980s. A: Schematic diagram demonstrating close interaction between members of the operating team expansion of the frontal bandeau, providing a fixed structure to which can make complex operations proceed smoothly. Many the advanced midface and frontal bones can be attached. B–E: Lat- of Tessier’s protégés describe him as the founding father eral and frontal views of a patient with Crouzon syndrome before (B in the same manner that Cushing’s trainees tracked their and C) and after (D and E) monobloc frontofacial advancement. The lineage back to him.42 There are more than a few similari- surgery restores normal cosmesis, which would have otherwise not been possible with the older technique utilizing a Le Fort III osteotomy. ties that stand out in reading descriptions of Cushing and Reproduced with permission from A Man from Héric: The Life and Work Tessier—the thoroughness of their physical examination, of Paul Tessier, MD, Father of Craniofacial Surgery. Figures 10.7 and obsessive attention to detail, multidisciplinary training, 10.8. Copyright S. Anthony Wolfe. and experience in treating trauma during war.42 A quote

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Unauthenticated | Downloaded 10/06/21 06:02 AM UTC The legacy of Paul Tessier from Tessier’s opening address in 1985 may have come 9. Foltz EL, Loeser JD: Craniosynostosis. J Neurosurg 43:48– from either: “Do not only work hard; do not work for 5 57, 1975 or 10 years on a problem; and do not work continuously 10. Frodel JL Jr, Marentette LJ, Quatela VC, Weinstein GS: Cal- varial bone graft harvest. Techniques, considerations, and mor- on a problem. My advice is hard continuous work for 30 bidity. Arch Otolaryngol Head Neck Surg 119:17–23, 1993 years.”24 Tessier’s experience spanned nearly 50 years 39 11. Gillies H, Harrison SH: Operative correction by osteotomy of (1946–1996) and 9500 procedures. recessed malar maxillary compound in a case of oxycephaly. While others before him had managed some treat- Br J Plast Surg 3:123–127, 1950 ment of craniosynostosis and other craniofacial deformi- 12. Giuffrè R, Vagnozzi R, Savino S: Infantile craniosynostosis: ties, what made Tessier stand out most was his stubborn- clinical, radiological, and surgical considerations based on ness that “If it’s not normal it’s not enough.”13 100 surgically treated cases. Acta Neurochir (Wien) 44:49– Beyond working assiduously in the clinical realm, he 67, 1978 13. Guichard B, Davrou J, Neiva C, Devauchelle B: Midface os- aggressively pursued various hobbies. When told to relax teotomies lines: evolution by Paul Tessier, the second Tessier after his bout of grave illness from myocarditis, he took 21 classification. J Craniomaxillofac Surg 41:504–515, 2013 up rowing. He was also known to be an active racecar 14. Guiot G, Derome P: [Apropos of meningiomas “en plaque” of driver, scuba diver, and avid safari hunter.43 the pterion. Surgical treatment of hyperostotic osseous menin- As has been said about him, “Paul Tessier was coura- giomas.] Ann Chir 20:1109–1127, 1966 (Fr) geous, noble, and wise, a French trilogy of Sir Lancelot, 15. Guiot G, Pecker J: Traitement du tremblement parkinsonien Ambroise Paré, and Louis Pasteur reborn in a single mod- par la pyramidotomie pédonculaire. Sem Hop 25:2620–2624, ern man. Just as he taught by example, he also led by it.”28 1949 16. Guiot G, Tessier P, Godon A: [Is it necessary to operate on meningioma “en plaque” of the sphenoid bone?] Minerva Acknowledgment Neurochir 14:293–304, 1970 (Fr) We offer special thanks to Dr. S. Anthony Wolfe for sharing 17. Hemmy DC: Docteur Paul Tessier, chirurgien plastique: a per- images, wisdom, and firsthand knowledge of Dr. Tessier. sonal remembrance. Ann Plast Surg 67:S16–S24, 2011 18. Hunter AG, Rudd NL: Craniosynostosis. I. Sagittal synostosis: its genetics and associated clinical findings in 214 patients Disclosure who lacked involvement of the coronal suture(s). Teratology The authors report no conflict of interest concerning the mate- 14:185–193, 1976 rials or methods used in this study or the findings specified in this 19. Ingraham FD, Alexander E Jr, Matson DD: Clinical studies paper. in craniosynostosis analysis of 50 cases and description of a Author contributions to the study and manuscript preparation method of surgical treatment. Surgery 24:518–541, 1948 include the following. Conception and design: all authors. Acquisi- 20. Jacobi A: Non Nocere. New York: Trow Directory, 1894 tion of data: Ghali, Srinivasan. Analysis and interpretation of data: 21. Jones BM: Paul Louis Tessier: plastic surgeon who revolution- all authors. Drafting the article: Ghali, Srinivasan. Critically revising ised the treatment of facial deformity. J Plast Reconstr Aes- the article: Lam, Jea. Reviewed submitted version of manuscript: all thet Surg 61:1005–1007, 2008 authors. Approved the final version of the manuscript on behalf of all 22. Lane LC: Pioneer craniectomy for relief of mental imbecility authors: Lam. Administrative/technical/material support: Lam, Jea. due to premature sutural closure and microcephalus. JAMA Study supervision: Lam, Jea. 18:49–50, 1892 23. Lannelongue M: De la craniectomie dans la microcéphalie. Compt Rend Seances Acad Sci 50:1381–1385, 1890 References 24. Marchac D: Craniofacial Surgery: Proceedings of the First 1. Babler WJ, Persing JA, Winn HR, Jane JA, Rodeheaver GT: International Congress of the International Society of Compensatory growth following premature closure of the Cranio-Maxillo-Facial Surgery, Cannes-La Napoule, 1985. coronal suture in rabbits. J Neurosurg 57:535–542, 1982 New York: Springer, 1987 2. Barritt J, Brooksbank M, Simpson D: Scaphocephaly: aesthet- 25. Marchac D, Arnaud E: Midface surgery from Tessier to dis- ic and psychosocial considerations. Dev Med Child Neurol traction. Childs Nerv Syst 15:681–694, 1999 23:183–191, 1981 26. Marchac D, Renier D: [Early treatment of facial-craniosteno- 3. Boggio-Robutti G, Sanvenero-Rosselli G: Transactions of the sis (Crouzon-Apert) (author’s transl).] Chir Pediatr 21:95– Fourth International Congress of Plastic and Reconstruc- 101, 1980 (Fr) tive Surgery, Rome, October 1967. Amsterdam: Excerpta 27. Mazzola RF: In memory of Paul Tessier, MD (1917-2008). J Medica Foundation, 1969 Craniofac Surg 20:3, 2009 4. Cutting CB, McCarthy JG: Comparison of residual osseous 28. McKinnon M: Le refabricant des orbites: a tribute to Paul Tes- mass between vascularized and nonvascularized onlay bone sier. Ann Plast Surg 67:S36–S41, 2011 transfers. Plast Reconstr Surg 72:672–675, 1983 29. McLaurin RL, Matson DD: Importance of early surgical treat- 5. Derome PJ, Tessier P: Craniofacial reconstruction in patients ment of crainosynostosis; review of 36 cases treated during with craniofacial malformations: the neurosurgical approach. the first six months of life. Pediatrics 10:637–652, 1952 Clin Neurosurg 24:642–652, 1977 30. Mehta VA, Bettegowda C, Jallo GI, Ahn ES: The evolution of 6. Epstein N, Epstein F, Newman G: Total vertex craniectomy surgical management for craniosynostosis. Neurosurg Focus for the treatment of scaphocephaly. Childs Brain 9:309–316, 29(6):E5, 2010 1982 31. Mouly R: Guiot, G., Rougerie, J., Tessier, P.: The dermal graft. 7. Faber HK, Towne EB: Early craniectomy as a preventative mea- Procedure of protection of the cerebral meninges and the blind- sure in oxycephaly and allied conditions. With special reference age duremerien. Ann. Chir. plast., 12: 93, 1967. Plast Reconstr to the prevention of blindness. Am J Med Sci 173:701–711, Surg 42:286, 1968 (Letter) 1927 32. Munro IR: Orbito-cranio-facial surgery: the team approach. 8. Faber HK, Towne EB: Early operation in premature cranial Plast Reconstr Surg 55:170–176, 1975 synostosis for the prevention of blindness and other sequelae: 33. Patel SK, Husain Q, Eloy JA, Couldwell WT, Liu JK: Norman Five case reports with follow-up. J Pediatr 22:286–307, 1943 Dott, Gerard Guiot, and Jules Hardy: key players in the resur-

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rection and preservation of transsphenoidal surgery. Neuro- 42. Wolfe SA: The influence of Paul Tessier on our current treat- surg Focus 33(2):E6, 2012 ment of facial trauma, both in primary care and in the man- 34. Posnick JC: Orthognathic Surgery: Principles & Practice. agement of late sequelae. Clin Plast Surg 24:515–518, 1997 St. Louis: Elsevier Saunders, 2014 43. Wolfe SA: A Man from Héric: The Life and Work of Paul 35. Tessier P: The definitive plastic surgical treatment of the se- Tessier, MD, Father of Craniofacial Surgery. Raleigh, NC: vere facial deformities of craniofacial dysostosis. Crouzon’s Lulu Enterprises Inc, 2012, Vol 1 and Apert’s diseases. Plast Reconstr Surg 48:419–442, 1971 44. Wolfe SA: A Man from Héric: The Life and Work of Paul 36. Tessier P: An interview with Paul Tessier conducted by Lars Tessier, MD, Father of Craniofacial Surgery. Raleigh, NC: M. Vistnes, M.D. Ann Plast Surg 18:352–354, 1987 Lulu Enterprises Inc, 2012, Vol 2 37. Tessier P, Guiot G, Derome P: Orbital hypertelorism. II. Defi- 45. Wolf SA: Paul Tessier, creator of a new surgical specialty, is nite treatment of orbital hypertelorism (OR.H.) by craniofa- recipient of Jacobson Innovation Award. J Craniofac Surg cial or by extracranial osteotomies. Scand J Plast Reconstr 12:98–99, 2001 Surg 7:39–58, 1973 46. Wolfe SA, Morrison G, Page LK, Berkowitz S: The monobloc 38. Tessier P, Guiot G, Rougerie J, Delbet JP, Pastoriza J: [Cranio- frontofacial advancement: do the pluses outweigh the minus- naso-orbito-facial osteotomies. Hypertelorism.] Ann Chir es? Plast Reconstr Surg 91:977–989, 1993 Plast 12:103–118, 1967 (Fr) 39. Tessier P, Kawamoto H, Matthews D, Posnick J, Raulo Y, Tu- lasne JF, et al: Autogenous bone grafts and bone substitutes— Manuscript submitted December 15, 2013. tools and techniques: I. A 20,000-case experience in maxil- Accepted February 17, 2014. lofacial and craniofacial surgery. Plast Reconstr Surg 116 (5 Please include this information when citing this paper: DOI: Suppl):6S–24S, 2005 10.3171/2014.2.FOCUS13562. 40. Vollmer DG, Jane JA, Park TS, Persing JA: Variants of sagit- Address correspondence to: Sandi Lam, M.D., Department of tal synostosis: strategies for surgical correction. J Neurosurg Neurosurgery, Baylor College of Medicine/Texas Children’s Hospi- 61:557–562, 1984 tal, 6701 Fannin St., Ste. 1230, Houston, TX 77030. email: sklam@ 41. Watts G: Paul Tessier. Lancet 372:368, 2008 texaschildrens.org.

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