Hemifacial microsomia is a descriptive term of developmental malformation affecting the first and second branchial arches, which is the second most common facial anormaly after cleft lip and palate.
A wide variety of phenotypes exist, all having the common feature of asymmetric underdevelopment of the face.
Most patients with hemifacial microsomia need 3 dimensional correction of facial skeleton. But if the patient is very young child, we have to consider another factor, growth. The fourth dimension, growth, adds to the complexity of the 3-dimensional defect. So detailed and careful skeletal and soft tissue analysis based on the patients age (dentition) and anatomic skeletal type is necessary.
Recently early skeletal surgery including even LeFort I. maxillary osteotomy has been done as early as the age of 4 or 5. The advantage of early skeletal surgery leveling everthing in a shot operation is to let young child go to shcool looking normal and with a chance of a normal life.
This is a report of our analysis and treatment of the hemifacial microsomia based on a recent 2 year experience with 27 patients.
The results are summarized as follows;
1. The sex ratio was 2:7 with a greater prevalence in females. The most common age incidence was between 20 and 29 and 5 patients were in deciduous dentition.
2. 1 case was bilateral type, and left side facial deformity was remarkably more common than right (17:10). Of 27 patients, 9 had ear deformity (33%) and 1 had cranial nerve involvement.
3. 25 of 27 patients had operative procedures to correct the skeletal deformities. 13 of 14 skeletal type I patients, mean age of 25.4 years, 10 of 11 type Ⅱ patients, mean 17.1 years. All of 2 type Ⅲ patients, mean age 12 years.
4. Of 20 patients in permanent dentition, 13 had type I of 4 patients in deciduous dentition, 3 had type Ⅱ mandible. I in mixed dentition had type Ⅱ mandible.
5. 25 patients have had surgical correction. Contour restoration operations (type 1) were performed in 8 patients, LeFort 1½ maxillary osteotomies and bilateral ramus operations (type 2) in 12 patients, unilateral temporomandibular joint constructions in 2 patients, LeFort 1½ osieotomy and unilateral temporomandibular joint construction in 1 patient, and LeFort 1½ osteotomies and unilateral temporomandibular joint constructions and contralateral ramus operations in 2 patients.
6. There were no major complications. Only one of 25 patients had minor complication, superficial infection necessitating drainage and irrigation with antibiotics solution.
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