In the past, hemifacial microsomia has been treated by a variety of method, depending of the severity of defect and preference of the surgeons.
In milder forms, only bone graft, either from the rib or ilac crest, have been utilized to correct bone defect. Cartilage graft, onlay acrylic implants and bilateral mandibular osteotomies with bone grafts have been used to correct hypoplastic ramus. In more severe cases in which the occlusal plane is slanted because of underdevelopement of the maxilla on affected side, surgical reposition of the maxilla has been advocated in conjuction with mandibular osteotomy. In the most severe forms, rib graft has been used to reestablish the missing glenoid fossa, hypoplastic temporal bon, zygomatic arch and lateral orbital rim.
Converse (1973) and others recommended to perform corrective procedure on mandible at selected intervals during facial growth and surgery be initiated when child is as young as eight or nine. The disadvantage of this approach is need for prolonged rteatment and multiple operation.
Munro (1980) performed early one-stage construction of the absent temporoman dibular joint with costochondral graft and simultaneous reposition of the facial skeleton in children with hemifacial microsomia. This based of the theory the transplant will result in symmetrical facial growth. Autogenous costochondral graft have shown promissing result.
The principle "first the bone, rarely the soft tissue" have evolved when skeleton is correct, the soft tissue assume a normal condition.
Here we present two cases of hemifacial microsomia corrected by LeFort osteotomy, ramus osteotomy, genioplasty and rib bone graft.
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