[The first- and second-arch syndrome. A treatment analysis and plan]

There is a very great lesion staging in these syndromes, and a great number of procedures have been described, according to the age and severity of the lesions. The initial assessment is therefore important, since it allows classifying these malformations according to their severity in key sectors. Scheduling the treatment in time must take account of: growth, the necessity to perform successive operations in one region, since no operation must hinder a subsequent one. It is essential to determine the optimum time for bone reconstruction. An early treatment with a conventional bone graft, without any intrinsic growth potential, condemns the reconstructed region to immobility, therefore to a progressive degradation of the result in time and to successive corrections. Early reconstruction is justified only if the available reconstruction means allow the reconstructed area to grow, either naturally or with the aid of orthopaedic stimulation. Some means seem to be available to date. A choice must therefore be made between: delayed morphological surgery, early functional surgery. Considering the extent of the means implemented, this is reserved for severe cases. The other great problem is the reconstruction of the auricle, which most often requires a series of operations scheduled over 2 years. The middle ear may not be operated if the lesions are unilateral. The other malformations, including macrostomia, muscular and neural abnormalities, involvement of the eyelids, sometimes require correction, which must fit in a repair schedule that must be established as soon as possible and must take account of the predictable procedures in order to prevent them from hindering each other.