Skeletal correction in craniofacial microsomia: a case series and algorithm for management

Craniofacial microsomia is the second most common congenital anomaly of the head and neck region. The associated facial asymmetry due to mandibular hypoplasia, whether unilateral or bilateral, is a prominent feature of the disorder. Surgical management of the skeletal deformity is dependent on the grade of severity of the affected sides. Prepubertal interventions in patients with Kaban type IIB or III include condyle-ramus reconstructions as a prelude to final orthognathic correction of the facial asymmetry and occlusion. This retrospective study of the skeletal management of 29 patients with craniofacial microsomia was conducted to outline their surgery and to suggest an algorithm for future treatment of this condition. Fourteen patients were classified as Kaban type I or II and underwent one or more orthognathic surgical procedures at the completion of growth. Fifteen patients with type IIB or III mandibular deformities had costochondral graft temporomandibular joint reconstructions. Reduced mandibular opening due to progressive ankylosis occurred in seven of these patients (47%), but this was treated successfully with release and subsequent orthognathic surgery. With the more recent addition of total joint replacement in craniofacial microsomia, there remains a wide divergence of opinion regarding early surgery. An algorithm for the management of the mandibular deformity is presented.