Treatment Of Hemifacial Microsomia Research Articles

Multidisciplinary Treatment of Hemifacial Microsomia: Several Clinical Cases

Hemifacial microsomia is the second most common congenital anomaly of the craniofacial region. Hemifacial microsomia is characterised by unilateral hypoplasia of the ear. Treatment of this condition depends on the severity of the lesion. The treatment of hemifacial microsomia must be carried out by a multidisciplinary group of professionals familiar with this pathology, including plastic surgeons, parapsychologists, orthodontists, and paediatricians. In hemifacial microsomia, microtia is usually accompanied by alterations of the middle ear. Since the ear develops embryonically from the first and second branchial arches, the facial areas that also develop from these embryonic origins are usually affected to a greater or lesser degree, including through hypoplasia of the jaw, maxilla, zygomatic bones, and temporal bone, among others. Although jaw hypoplasia is the most evident deformity in craniofacial microsomia, microtia is the alteration that often has the greatest aesthetic impact on patients. Alterations in dentition are also common, typically presenting as a cephalad inclination of the anterior occlusal plane of the maxilla and mandible on the affected side. This study aims to review the surgical approach and evaluate the results of a paediatric case of hemifacial microsomia. Hemifacial microsomia is present at birth, and successful reconstruction is essential for the correct integration of such infantile patients into society. Multiple facial asymmetries as well as neonatal onset are a challenge for reconstructive surgery, and the importance of multidisciplinary treatment in these patients must be emphasised.

A new treatment strategy for hemifacial microsomia: Auricular reconstruction with an expanded two-flap method and simultaneous mandibular distraction osteogenesis

Owing to the complex clinical manifestations of hemifacial microsomia (HFM), multidisciplinary cooperation is required to achieve better therapeutic effects in terms of function and aesthetics. This study aimed to explore the efficacy of the expanded two-flap auricular reconstruction combined with mandibular distraction osteogenesis in the treatment of HFM. This surgical strategy was performed in three stages. In the first stage, the retroauricular skin was expanded with a tissue expander and a mandibular distraction device was installed. In the second stage, the traditional expanded two-flap method for auricular reconstruction was adapted, and the framework was fabricated with costal cartilage and wrapped with the expanded skin flap, retroauricular fascia flap, and full-thickness skin graft. In the final stage, the tragus and lobule were rebuilt, the concha cavity deepened, and the mandibular distraction device removed. From January 2014 to November 2018, 166 HFM patients underwent auricular reconstruction with the expanded two-flap method and simultaneous mandibular extension in our hospital. The median follow-up period was 9.3 months. Of the 166 patients, 154 patients and their families were satisfied with the results, and only 16 patients experienced complications. This three-stage technique of simultaneous auricular reconstruction and mandibular distraction osteogenesis is safe and effective in achieving facial symmetry, improving occlusal contact, shortening treatment course, and relieving patient's suffering, especially for HFM patients.

Treatment of hemifacial microsomia using conventional orthodontic techniques: Report of a case with long-term follow-up

Background and OverviewThe authors successfully treat a case of hemifacial microsomia involving unilateral condylar hypoplasia using conventional orthodontic techniques followed by long-term retention. Case DescriptionA girl aged 10 years and 2 months received a diagnosis of hemifacial microsomia resulting from unilateral condylar hypoplasia. During a growth period, premature incisal contact was abolished. After her growth was complete, she received conventional orthodontic treatment with preadjusted edgewise appliances. After 27 months of multibracket treatment, acceptable occlusion with a class I canine and molar relationship was achieved. The occlusion remained stable throughout the 15-year retention period, although there was a slight facial change. Conclusions and Practical ImplicationsEarly orthodontic management only can have some limitations but could be one of the treatment options for hemifacial microsomia.

Applications of Computer-Aided Design/Manufacturing Technology in Treatment of Hemifacial Microsomia.

Computer-aided surgery has been widely used in treatment of hemifacial microsomia and matured in recent decades. These techniques include the computer-aided design, virtual surgical planning, modeling surgery, rapid prototyping techniques, intraoperative navigation and so on. The purpose of this article is to summarize the current application of computer-aided design/computer-aided manufacturing technology in the treatment for hemifacial microsomia during the last 5 years, as well as the views and discussions on some topics, and finally introduce a method of our team. Our effort is that using the holes predrilled in cutting guides, the pre-bent titanium plates are easily placed. Avoiding potential bone autorotation caused by unfitness between conventional titanium plates and bone surface, which keeps the bone fixation precisely in line with the preoperative virtual plan and reduce the movement of bone segments due to the undesirable stress of the plates.

The accuracy of virtual-surgical-planning-assisted treatment of hemifacial microsomia in adult patients: distraction osteogenesis vs. orthognathic surgery

Hemifacial microsomia (HFM) is a common congenital craniofacial deformity with a high prevalence. Orthognathic surgery and distraction osteogenesis are two conventionally used treatments of HFM. The main objective of this retrospective study was to evaluate the accuracy of two treatments with the help of virtual surgical planning in adult HFM patients. Sixty-eight adult patients with unilateral HFM were enrolled in this study. Preoperative surgical planning and simulation were performed on three-dimensional computed tomography models. Orthognathic surgery or distraction osteogenesis was performed under the guidance of three-dimensional surgical templates. Postoperative evaluation of the intervention was performed by comparison of the affected ramus height, chin deviation and the occlusal cant in surgical planning and actual result. Outcome and feedback information (an average of 14 months) showed that virtual surgical planning was accurately transferred to actual surgery in both surgical approaches. There were no statistical differences between the accuracy of affected ramus height and the occlusal cant in two surgical approaches. The orthognathic group showed significantly higher accuracy in chin deviation. In conclusion, virtual surgical planning and three-dimensional surgical templates were proved to facilitate treatment planning and offer an accurate surgical result in the treatment of adult HFM patients.

A novel step osteotomy for correction of hemifacial microsomia – A case report

Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000–5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of the mandible by means of a novel modified step osteotomy to correct the facial asymmetry in a case of hemifacial microsomia without disturbing the occlusion. This novel technique can prove to be a new tool in the maxillofacial surgeons armamentarium to treat facial asymmetry.

Treatment of Hemifacial Microsomia: A Case Report

Introduction: Hemifacial microsomia (HFM) is a branchial arch syndrome and the second most common craniofacial birth defect after cleft lip and palate. This syndrome involves the facial skeleton and ear. The most important goal in treatment of HFM is to improve facial symmetry. Traditionally, segment repositioning and costochondral graft were used for the correction of mandibular asymmetry but recently distraction osteogenesis has been used for it. Case Presentation: In this article an 8-year-old boy with HFM is presented. He was treated with functional appliance for one year and then at 9 years age distraction osteogenesis was performed for him and at the age of 18, maxillary impaction (right side: 3mm, left side: 13 mm), BSSO of mandible and reduction genioplasty were done for the functional and esthetic reconstruction of the face. Conclusions: Satisfactory results were obtained in the patient.

Surgical guide assistant mandibular distraction osteogenesis and sagittal split osteotomy in the treatment of hemifacial microsomia.

Hemifacial microsomia is the second most common congenital craniofacial malformation after cleft lip/palate with a wide variety of pathologic expression in jaws, skeletal components, ears, and soft tissues. Among the deformities, mandibular hypoplasia is the most common and is the main component that affects facial asymmetry. Mandibular distraction osteogenesis is the mainstay treatment; however, the vector of device and osteotomy lines need to be well designed. We utilized the sagittal split osteotomy for mandibular distraction with rapid prototyping surgical guide plate, making a successful outcome. Hemifacial microsomia with unilateral Pruzansky II mandibular hypoplasia were selected in this study. Three-dimensional CT reconstructive data was put into Proplan CFM for preoperative designing and then manufacturing the surgical guide plate. The mandibular osteotomy and implantation of the internal distractor were performed through an intraoral approach aided with the prefabricated guide plate. Distraction began 7 days postoperation with a frequency of 1 mm/d and the distractor was kept in place 6 to 10 months after the first operation, then the distractor was removed. From July 2012 to March 2014, 6 cases of Pruzansky II hemifacial microsomia aged from 7 to 11 years were treated with the technique mentioned above. The range of distraction extends from 20 to 30 mm. The facial asymmetry deformities were improved obviously and without any complication. Mandibular distraction osteogenesis by sagittal split osteotomy through rapid prototyping surgical guide plate provides certain advantages in the treatment of hemifacial microsomia.

My Trip to the XXI Congress of the European Association for Cranio-Maxillo-Facial Surgery

My Trip to the XXI Congress of the European Association for Cranio-Maxillo-Facial Surgery

Error analysis of a CAD/CAM method for unidirectional mandibular distraction osteogenesis in the treatment of hemifacial microsomia

Our aim was to investigate the errors in a computer-aided design and manufacture (CAD/CAM) method of unidirectional mandibular distraction osteogenesis. Six patients with hemifacial microsomia were selected, and studied on computed tomographic (CT) scans taken at 3 time intervals: preoperatively, at the end of the latent period, and at the end of consolidation. The plan for mandibular distraction osteogeneisis was designed using CT-based 3-dimensional visible software. The osteotomy line and site of the drill were transferred to a rapid prototyping surgical guide. The osteotomy of the mandible and implantation of the distraction device were completed under guidance. The accuracy of the transferred surgical plan was confirmed by fusion of images after the latency period. The 3-dimensional superimposition of the preoperative simulation, and the postoperative actual models at the end of consolidation, showed that the mean (SD) error between the actual and the predicted height of the ramus was 0.6 (0.6)mm. The error between the actual and predicted intercondylar distance was 8.1 (2.1)mm. There was a significant difference in intercondylar distance between the simulated and actual groups (p=0.00024). The 3-dimensional CT-based planning system described in this paper was transferred precisely from the virtual plan to the real-time operation. The planning system also gave a precise prediction of the height of the ramus after mandibular distraction osteogenesis. However, because of the pull of the lateral pterygoid muscle and pseudarthrosis, the intercondylar distance decreased compared with the predicted value. These influencing factors should be considered when the planning system is refined.

Endoscopic abdominoplasty providing a perforator fat flap for treatment of hemi-facial microsomia

A patient with a history of an extended unilateral hemifacial cleft desired the restoration of the buccal fat on the hollow cheeked side and also wished to reduce an abdominal bulge at the same time. The amount of tissue volume needed exceeded the possibilities of free autologous fat grafting, lipofilling and allogenic implants. Therefore a free fat flap with microvascular anastomoses harvested as part of a minimal invasive abdominoplastic procedure using an incision well hidden within the bikini zone was the most attractive surgical option. This is the first case reported, where the standard free deep inferior epigastric artery (DIEA) perforator flap was utilised.

Treatment of Hemifacial Microsomia with Unilateral Temporomandibular Joint Replacement (TMJ Concepts) in Conjunction with Bimaxillary Surgery

Treatment of Hemifacial Microsomia with Unilateral Temporomandibular Joint Replacement (TMJ Concepts) in Conjunction with Bimaxillary Surgery

Hemandibular Hypoplasia Successfully Treated with Functional Appliances: Is it Truly Hemifacial Microsomia?

The literature contains a number of case reports on successful orthopedic treatment of hemifacial microsomia (HFM), with surprising changes in the morphology of the condyles. All of these reports regard patients who have substantially no soft tissue involvement but only severe mandibular ramus and condyle deformities. A number of cases with unexpectedly similar phenotypes diagnosed as HFM are described. The authors suggest that it is possible that all of these cases might be misdiagnosed traumatic injuries of the condyle, which present a normal functional matrix and, therefore, with growth and with the help of functional stimulation, tend to grow toward the original symmetry.

Computer Simulation of Curvilinear Mandibular Distraction: Accuracy and Predictability

The purpose of this study was to retrospectively evaluate the accuracy and reliability of a computer simulation system that predicts the results of an internal curvilinear mandibular distractor in the treatment of hemifacial microsomia and severe mandibular retrognathia. A two-dimensional computer analysis and simulation system was developed based on cephalometric radiographs and patient photographs. The software was used to generate and superimpose digital templates, corresponding to the actual distractor and logarithmic spiral, onto the lateral cephalometric tracings. The digital distractor's template was then adjusted to fit the radiographic projection of the actual distractor on the 1-week postoperative lateral cephalograph as precisely as possible. It was then activated along the spiral growth curve template until the ideal position of the mandible was reached. This computational surgical simulation tracing was then superimposed onto the actual postdistraction lateral cephalometric radiograph and tracing. Thus, the predicted and actual mandibular distraction movements were compared. In all of the cases, the computational distraction (skeletal and soft tissues) tracing fit the actual postdistraction tracing with an accuracy to within 1 mm. The current study demonstrated that a specific curvilinear distraction can (1) closely reproduce the natural logarithmic spiral movement of the mandibular growth, (2) be closely approximated and thus predicted by a computer simulation system, and (3) be used for correction of mandibular deformities such as hemifacial microsomia and severe mandibular retrognathia.

Surgical treatment of hemifacial microsomia

To summarize the methods and experiences in surgical treatment of hemifacial microsomia. Fifty-eight cases of hemifacial microsomia that have been treated by plastic and reconstructive surgery and followed-up in our department during last 20 years have been reviewed. Every patient's characteristic was assessed by physical examination, photography, craniofacial cephalometry before planned the method of surgery. Different surgical treatments were chosen according to the side and the structures involved in the abnormalities and the severity of hemifacial microsomia, and the cases were followed up since 3 months after the treatments. The follow-up lean of midline of the lower 1/3 face with that before treatment is compared. The degrees of patients' and surgeons' satisfactions with the treatments were evaluated respectively. The average angle of lean of midline of skeletal and soft tissue of the lower 1/3 face decreased 4.2 degrees and 2.9 degrees respectively after treatment. Fifty (82.6%) cases satisfied with the outcome of the surgical treatment and surgeons satisfied with 84.5% of the outcome of all the cases. Individual surgical treatment based on the side and the structures involved in the abnormalities can effectively correct facial asymmetry of hemifacial microsomia.

Analysis and treatment of hemifacial microsomia

In the late forties, Braithwaite and Watson [1] reported this condition but it was not until the early sixties, that Gorlin and Pindborg provided a detailed description of hemifacial microsomia [2]. This complex and variable congenital anomaly involves the first and second brachial arches and the nasal placode. Usually it is unilateral, but in 5–15% it can be bilateral. A similar condition is Goldenhar’s syndrome, which is craniofacial microsomia and although other names have been coined, e.g. the first and second brachial arch syndrome, lateral facial dysplasia, facial auricular vertebral deformity, ocular auricular vertebral dysplasia and unilateral otomandibular dysostosis. Most cases are sporadic although autosomal dominant and recessive conditions have been reported. The syndrome has many features. In the ear area, there may be a microtia or preauricular abnormalities, and these can vary from severe to mild. There also may be cardiac or renal problems and deformity of the skeleton other than the facial skeleton. Goldenhar’s syndrome is characterized by the presence of epibulbar dermoids and involvement of the cervical spine, some patients have ear appendages. In terms of the hereditary aspect, this condition can occur in 1:5500 live births [3]. The full fledged Goldenhar’s syndrome, however, is seen only in 10% of cases. There have been many theories put forward as to why this condition occurs. Poswillo suggested that a hematoma in utero resulted in jaw and ear deformities because of the tissue damage produced by the hematoma [4]. It was suggested that this occurred at 30–45 days gestation. An alternative vascular causation was ischemia in the area supplied by the stapedial artery. Other causative factors can be thalidomide and primadone, accutane and isotretinoin, these substances cause neural crest cell damage. Acute exposure to alcohol can result in asymmetrical facial development. Hemifacial microsomia shows a low familial incidence [5, 6]. In addition to this, the expression of the condition is quite variable.

Distraction osteogenesis of the ascending ramus for mandibular hypoplasia using extraoral or intraoral devices: A report of 8 cases

The primary surgical objective in the treatment of hemifacial microsomia is to establish functional and asthetic facial anatomy that remains stable long-term. Mandibular ramus deficiency is the most conspicuous skeletal feature of this disorder. To early oral and maxillofacial surgeons, lengthening the deficient skeletal unit was the obvious solution, and lengthening osteotomies and grafts were used to replace the deficient skeletal portion. Despite predictable results using these techniques for orthognathic and trauma-related disorders, the results were often disappointing when applied to craniofacial deformities, particularly those involving lengthening the mandibular ramus. Relapse, continued abnormal growth, and temporomandibular joint degeneration are among factors that produced undesirable results. Important insight into the role of the deficient functional matrix associated with hemifacial microsomia was described by Harvold, 1 Harvold EP The theoretical basis for the treatment of hemifacial microsomia. in: Treatment of Hemifacial Microsomia. Liss, New York, NY1983 Google Scholar who incorporated functional appliance therapy before and after skeletal surgery. Combining functional appliance therapy with skeletal surgery improved treatment outcomes, but patients typically remained with variable expressions of the basic phenotype. Although treatment approaches to hemifacial microsomia vary, achieving stable skeletal lengthening remains a primary challenge in all of the current techniques, including distraction osteogenesis.

Analysis and Treatment of Hemifacial Microsomia in Childhood

Hemifacial microsomia (HFM) is not a fixed dysmorphic deformity, but rather a progressive, complex deformation, involving the soft tissues and skeletal structures derived from the first and second branchial arches. Secondary growth distortion is seen particularly in the failure of midface growth, because of inadequate mandibular vertical growth on the involved side. Based on this concept of a dysfunctional matrix, we treat HFM in childhood according to the severity of the mandibular hypoplasia. In the type I and type IIA children seen in the deciduous stage, we recommend use of an activator or functional appliance. The more severe type IIB and type III children with absent structures need early construction of the mandibular ramus, glenoid fossa, and temporomandibular joint. In so doing, we convert the severely hypoplastic mandible into a more symmetric and functional type IIA status. Correction of the mandible appears to maximize potential growth and minimize the documented secondary distortion in the maxilla. Preliminary study confirms that early correction minimizes the need for maxillary and orbital osteotomies as these patients enter adulthood. We have briefly outlined our approach to soft-tissue hypoplasia and neuromuscular deficiency in HMF. Further refinements are needed in these areas.

Classification and treatment of hemifacial microsomia

Classification and treatment of hemifacial microsomia

Classification and treatment of hemifacial microsomia.

On the basis of 37 surgically treated patients with hemifacial microsomia, an anatomical-surgical classification was developed which divides these patients into five categories to facilitate surgical planning and help standardize treatment. Treatment was founded on the cooperation of a large craniofacial team. Osteotomies of the jaws, construction of the TM joint with costochondral grafts, onlay bone grafts, and genioplasty were performed to improve facial form and function. Facial scars were avoided. After three-dimensional skeletal alignment, there was rarely a compelling need for subsequent soft tissue augmentation.