Simultaneous distraction osteogenesis and microsurgical reconstruction for facial asymmetry

Restoring facial balance in patients with severe facial asymmetry is a challenging problem for the craniofacial team. Attention to bony reconstruction as well as soft-tissue contouring is required for patients with moderate to severe deformities. Traditionally, facial skeletal reconstruction was performed with osteotomies and bone grafting. More recently, distraction osteogenesis has proven to be successful in achieving bone lengthening. For select cases, distraction osteogenesis has lessened the need for major skeletal procedures and has allowed earlier surgical intervention. The reconstruction of the soft tissues in facial asymmetry has generally been performed as a second-stage procedure after skeletal reconstruction. The disadvantage of these traditional approaches is that it requires two separate major operative procedures, with the accompanying increased morbidity, hospital stay, and cost. We present a patient with hemifacial microsomia and a grade III mandibular deformity, in whom both the hard- and soft-tissue deficiencies were corrected in one surgical procedure with mandibular distraction osteogenesis and soft-tissue augmentation with a vascularized parascapular osteocutaneous flap. The technique and results at 1-year follow-up are presented.