Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome

Parry-Romberg syndrome is an acquired facial deformity that manifests as progressive hemifacial atrophy that has unknown cause. Many surgical techniques to address it have been reported, such as fat transplantation and use of free flaps. Undoubtedly, the results of such techniques can be satisfactory for mild hemifacial atrophy after soft tissue restoration. But in severe cases, except for large-scale soft tissue atrophy, the osseous framework is involved, rendering their management difficult, and the results are often inadequate. On the basis of the severity of facial soft tissue atrophy and the extent of involvement of the osseous framework, we classified the deformities into 3 groups: (1) Mild: the facial atrophic area is confined to a small region and is located in the lateral face, the nasal ala and upper lip are normal, and there is no deviation of the oral commissure, and the occlusal plane is horizontal. (2) Moderate: there are large areas of soft tissue atrophy, and the nasal ala and upper lip are also affected; the oral commissure is deviated; the bony framework is nearly normal; and the occlusal plane is nearly horizontal or slightly deviated. (3) Severe: moderate form of soft tissue atrophy and serious bone framework atrophy, involving the zygoma, maxilla, and mandible; the chin and occlusal plane have deviated extensively to the affected side.In this article, we report our experience in successfully treating 23 patients with severe Parry-Romberg syndrome, according to our classification; mild and moderate cases were not included in this series. Microsurgical flap transplantation, lipoinjection, liposuction revision, dermis grafting, and cross-lip flap were used to correct soft tissue deformities, and bone augmentation using the MEDPOR implant, orthognathic surgery, bone grafting, and mandibular distraction were performed to reconstruct the bone framework.