Hemifacial microsomia: priorities and sequence of comprehensive otologic management

Hemifacial microsomia is evidenced by the clinical spectrum of microtia, mandibular deformities, and middle ear malformations. This constellation of defects suggests that the most efficacious treatment will be multidisciplinary management, which includes the otolaryngologist, audiologist, plastic surgeon, and temporal bone radiologist. In the past, microtia--the most clinically apparent malformation--usually has been studied and treated with respect to the area of special interest of the investigator, whether from an otologic, reconstructive, or radiologic perspective. Newer management, however, utilizes the combined skills of the clinical and behavioral disciplines in the treatment of the microtic auricle, associated middle ear pathology, and hearing loss. Such multidisciplined approach, commencing during the first year of life, is deemed advisable to cope with the severe unilateral or bilateral hearing loss which may lead to potentially serious sensory deprivation and impede adequate language development in these children.