World Journal of Surgery

, Volume 13, Issue 4, pp 396–400 | Cite as

Hemifacial microsomia

  • Michael D. Poole
Pogress Symposium—Progerss in Craniofacial Surgery

Abstract

Hemifacial microsomia is variable with respect to the degree of the deformity it presents, thus, treatment varies. Mild degrees of the condition are usually treated adequately by waiting until adolescence, when definitive surgical correction of any skeletal or soft tissue asymmetry can be dealt with. Some mild and moderate cases may benefit from orthodontic functional appliance therapy during growth, but orthodontic opinion is divided on the value of such therapy. Children with severe forms of hemifacial microsomia are improved in appearance during their school years by early surgery performed in the preschool period. A number of surgical approaches have been used at this stage. The technique currently being used by the author involves composite transfer of vascularized soft tissue for contouring, together with a vascularized costochondral strut to lengthen the affected side of the mandible. Early results using this method are satisfactory, but further work is required to assess the advantages of this over other techniques.

Résumé

Dans la microsomie hémifaciale, les malformations varient beaucoup: leur traitement aussi. Dans les formes peu évoluées, le traitement définitif des parties osseuses et/ou molles peut Être retardé jusqu'a l'adolescence. Quand les malformations sont plus importantes (forme modérée), le traitement, discuté en ce qui concerne son efficacité, consiste à mettre en place un appareil orthodontique pendant la croissance. En cas de forme sévère, il vaut mieux opérer l'enfant dans la péroide préscolaire. De nombreux procédés chirurgicaux sont possibles à ce stade. La technique que nous préférons à ce jour comporte un lambeau vascularisé composite comprenant des parties molles destinées à reformer le contour et un fragment chondrocostal qui vient allonger l'hémimandibule atteinte. Les premiers résultats de cette méthode sont satisfaisants mais d'autres études sont nécessaires pour comparer les avantages de cette technique à ceux des autres.

Resumen

La microsomia hemifacial varía en relación al grado de deformidad que presenta y, por lo tanto, el tratamiento es variable. Grados leves de deformidad son usualmente tratados en forma adecuada esperando a la adolescencia, cuando se pueda realizar una corrección quirÚrgica definitiva de la asimetría esquelética y de los tejidos blandos. Algunos casos leves y moderados pueden beneficiarse con dispositivos ortodóncicos durante la etapa de crecimiento, pero las opiniones sobre el valor de este tipo de terapia se hallan divididas. Los niños con formas graves de microsomia hemifacial pueden mejorar su apariencia durante la edad escolar mediante cirugía precoz realizada en el período preescolar. Se ha utilizado una variedad de técnicas en esta fase de la vida. Le técnica que actualmente utiliza el autor implica la transferencia de tejidos blandos vascularizados para dar contorno, junto con un segmento costocondral vascularizado para el alargamiento de la mandíbula. Los resultados precoces con este método son satisfactorios, pero se requiere estudio adicional para la valoración de ésta y de otras técnicas quirÚrgicas.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Poswillo, D.E.: The pathogenesis of the first and second branchial arch syndrome. Oral Surg.35:302, 1973Google Scholar
  2. 2.
    Grabb, W.C.: The first and second branchial arch syndrome. Plast. Reconstr. Surg.36:485, 1965Google Scholar
  3. 3.
    David, D.J., Mahatumarat, C., Cooter, R.D.: Hemifacial microsomia: A multisystem classification. Plast. Reconstr. Surg.80:525, 1987Google Scholar
  4. 4.
    Tessier, P.: Anatomical classification of facial, cranio-facial and latero-facial clefts. J. Maxillofac. Surg.4:69, 1976Google Scholar
  5. 5.
    Murray, J.E., Kaban, L.B., Mulliken, J.B.: Analysis and treatment of hemifacial microsomia. Plast. Reconstr. Surg.74:186, 1984Google Scholar
  6. 6.
    Kaban, L.B., Moses, M.H., Mulliken, J.B.: Correction of hemifacial microsomia in the growing child: A followup study. Cleft Palate J.23[Suppl. l]:50, 1986Google Scholar
  7. 7.
    Vargervik, K., Ousterhout, D.K., Farias, M.: Factors affecting long term results in hemifacial microsomia. Cleft Palate J.23[Suppl. 1]:53, 1986Google Scholar
  8. 8.
    Ware, W.H., Brown, S.L.: Growth centre transplantation to replace mandibular condyles. J. Maxillofac. Surg.9:50, 1981Google Scholar
  9. 9.
    Ware, W.H., Taylor, R.L.: Growth centre transplantation to replace damaged mandibular condyles. J. Am. Dental Assoc.73:128, 1966Google Scholar
  10. 10.
    Munro, I.R.: One-stage reconstruction of the temporomandibular joint in hemifacial microsomia. Plast. Reconstr. Surg.66:699, 1980Google Scholar
  11. 11.
    Ortiz-Monasterio, F.: Early mandibular and maxillary osteotomies for the correction of hemifacial microsomia: A preliminary report. Clin. Plast. Surg.9:509, 1982Google Scholar
  12. 12.
    Lauritzen, C., Munro, I.R., Ross, R.B.: Classification and treatment of hemifacial microsomia. Scand. J. Plast. Reconstr. Surg.19:33, 1985Google Scholar
  13. 13.
    Ortiz-Monasterio, F., Fuente del Campo, A.: Early skeletal correction of hemifacial microsomia. In Craniofacial Surgery, E. Caronni, editor, Boston, Little, Brown and Company, 1985, p. 401Google Scholar
  14. 14.
    LaRossa, D., Whitaker, L., Dabb, R., Mellissinos, E.: The use of microvascular free flaps for soft tissue augmentation of the face in children with hemifacial microsomia. Cleft Palate J.17:138, 1980Google Scholar
  15. 15.
    Obwegeser, H.L.: Correction of the skeletal anomalies of otomandibular dysostosis. J. Maxillofac. Surg.2:73, 1974Google Scholar
  16. 16.
    Richards, M.A., Poole, M.D., Godfrey, A.M.: The serratus anterior/rib composite flap in mandibular reconstruction. Br. J. Plast. Surg.38:466, 1985Google Scholar
  17. 17.
    Godfrey, A.M., Bailey, B.N.: Grabb's Encyclopaedia of Flaps, W.C. Grabb, B. Strauch, L.O. Vasconez, editors, Boston, Little, Brown and Company(in press) Google Scholar
  18. 18.
    Donski, P.K., Carwell, G.R., Sharzer, L.A.: Growth in revascularised bone grafts in young puppies. Plast. Reconstr. Surg.64:239, 1979Google Scholar
  19. 19.
    Wray, R.C., Mathes, S.M., Young, V.L., Weeks, P.M.: Free vascularised whole-joint transplants with ununited epiphyses. Plast. Reconstr. Surg.67:519, 1981Google Scholar
  20. 20.
    Nettelblad, H., Randolph, M.A., Weiland, A.J.: Heterotopic microvascular growth plate transplantation of the proximal fibula: An experimental canine model. Plast. Reconstr. Surg.77:814, 1986Google Scholar
  21. 21.
    Cutting, C.B., McCarthy, J.G.: Comparison of residual osseous mass between vascularised and nonvascularised onlay bone transfers. Plast. Reconstr. Surg.72:672, 1983Google Scholar
  22. 22.
    Moss, M.L., Salentijn, L.: The primary role of functional matrices in facial growth. Am. J. Orthodont.55:566, 1969Google Scholar
  23. 23.
    Poole, M.D.: A composite flap for early treatment of hemifacial microsomia. Br. J. Plast. Surg.42:163, 1989Google Scholar

Copyright information

© Société Internationale de Chirurgie 1989

Authors and Affiliations

  • Michael D. Poole
    • 1
  1. 1.Oxford Craniofacial UnitRadcliffe InfirmaryOxfordUK

Personalised recommendations