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Factors affecting long-term results in hemifacial microsomia
The Cleft Palate Journal
|December 1, 1986
Summary
Functional appliance treatment showed no significant difference in mandibular ramus length increase in patients with hemifacial microsomia. Surgical repositioning and bone grafting yielded varied results, with some patients maintaining symmetry and others requiring revision surgery.
Area of Science:
- Craniofacial surgery
- Orthodontics
- Pediatric dentistry
Background:
- Hemifacial microsomia often involves mandibular malformations, impacting facial symmetry and function.
- Treatment strategies aim to correct mandibular hypoplasia and improve aesthetics.
- Understanding growth potential and surgical outcomes is crucial for effective management.
Purpose of the Study:
- To evaluate mandibular growth response to functional appliance therapy in Type I hemifacial microsomia.
- To assess the changes in mandibular ramus length after surgical repositioning and bone grafting during and after the growth period.
Main Methods:
- A cohort of 15 patients with Type I hemifacial microsomia received functional appliance treatment, with mandibular ramus length changes monitored.
- A separate group of 25 patients underwent surgical repositioning and bone grafting, with outcomes analyzed based on growth status (during vs. after growth period).
Main Results:
- Functional appliance treatment did not result in significantly different length increases between the affected and unaffected mandibular rami.
- Surgical intervention during the growth period led to additional ramus lengthening, though generally less than the contralateral side.
- Symmetry was maintained in 7/10 growing subjects post-surgery; 3 experienced asymmetry recurrence, with 2 requiring secondary lengthening.
- Minimal length loss was observed in non-growing subjects post-surgery, with stable mandibular position.
Conclusions:
- Functional appliance therapy shows limited efficacy in significantly increasing mandibular ramus length in Type I hemifacial microsomia.
- Surgical correction with bone grafting can achieve mandibular lengthening, with varying degrees of success and potential for asymmetry recurrence, especially during the growth phase.
- Careful surgical planning and potential for revision are important considerations for managing mandibular hypoplasia in hemifacial microsomia.