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.
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Poole, M.D. Hemifacial microsomia. World J. Surg. 13, 396–400 (1989). https://doi.org/10.1007/BF01660752
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DOI: https://doi.org/10.1007/BF01660752