Orthodontic considerations for patients presenting with Goldenhar Syndrome: A long-term case report

Abstract

Abstract Introduction The correction of facial asymmetry in patients presenting with Goldenhar Syndrome can be challenging due to the complexity of the orthodontic and surgical procedures required, the psychosocial considerations of the patient and the risk of relapse. Materials and methods A Caucasian male with Goldenhar Syndrome originally presented at age 8.2 years with concerns relating to a poor bite. He had previously undertaken surgery for the removal of pre-auricular skin tags on the right side. With ongoing skeletal growth, the facial asymmetry became more obvious and caused the patient to become socially withdrawn. Multidisciplinary treatment involving orthodontics and orthognathic surgery to correct the mandibular asymmetry was delayed until facial growth had slowed. The correction involved the use of an asymmetrical bilateral sagittal split osteotomy and an advancement genioplasty followed by a dermal fat graft and MedporR onlay to the right mandibular body and angle in addition to a refinement genioplasty. Results Follow-up has revealed a partial return of a buccal openbite illustrating the risk of occlusal relapse. Conclusion The case report illustrates the complexity of the orthodontic and surgical management of facial asymmetry, the psychosocial considerations of the patient and the risk of relapse. Multidisciplinary management is essential in the management of Goldenhar Syndrome.