The first and second arch syndrome is misnamed. It is a first and second arch plus a tubotympanic pouch syndrome, which is a completely different matter. Unequal progress of these formations, fusing with the pneumatization at birth, reaches a working level normally after 4 years of age. Abnormally, it takes longer. Malformations of this syndrome involve three components: microtia, auricular atresia, and hemifacial microsomia. The three components are always present, to a major or minor degree, but they compose one syndrome. Diagnosis involves all three parts. Optimal treatment also includes the three parts, and entails the least amount of surgery, performed in the shortest period of time, and resulting in an appropriate improvement for the patient; it is not simply a pastime for the surgeon.
KeywordsBone Graft Facial Nerve Skin Graft Skin Flap Plastic Surgeon
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