Surgery-first for a patient with mild hemifacial microsomia: A case report and review of literature

BACKGROUND Hemifacial microsomia(HFM)is the second most common craniofacial congenital anomaly following cleft lip and palate.Because of the various phenotypic spectra and the severity of the deformity,a wide range of treatment approaches have been proposed.Recently,the surgery-first approach(SFA)was introduced to treat mild to moderate HFM,and it yielded a balanced facial appearance.The SFA not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.CASE SUMMARY A female patient,aged 25 years old,sought orthodontic treatment with the chief complaint of dental and facial asymmetry.After a comprehensive physical examination and imaging analysis were performed,the patient was diagnosed with mild HFM that was primarily attributed to unilateral abnormal development of the maxilla-mandibular.The SFA was carried out to correct the skeletal deformity.The palatal suture was used as the midline of the maxilla in the surgical plan to center the maxilla,and the chin was also properly positioned to obtain a relatively symmetrical facial appearance.Four weeks after the surgery,the patient was referred for postsurgical orthodontics to decompensate the dentition and stabilize the occlusion.After 20 mo of treatment,all orthodontic appliances were removed.The posttreatment photographs of the patient and her smile confirmed good aesthetic and occlusal results.CONCLUSION Mild HFM can be corrected by SFA,which not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

Ipsilateral hemifacial microsomia with dextrocardia and pulmonary hypoplasia:A case report

BACKGROUND Hemifacial microsomia(HFM)is a rare congenital malformation characterized by a combination of various anomalies,including the face,ears,eyes,and vertebrae.Prenatal diagnosis for HFM is possible,and quite accurate ultrasound can detect obvious defects.The etiology is still unknown,although some hypotheses have been proposed,including gene mutation,chromosome anomaly,and environmental risk factors.However,there are few reports of pulmonary hypoplasia and dextrocardia in HFM.CASE SUMMARY A 2-year-old boy presented to the ear reconstruction department of our hospital complaining of deviation of the face to the right side and auricular anomaly.Physical examination revealed facial asymmetry,preauricular skin tags,and concha-type microtia with stricture of the external auditory canal on the right side.Head magnetic resonance imaging showed bilateral semicircular canal dysplasia and bilateral internal auditory canals stenosis.Audiometric examination showed bilateral severe sensorineural hearing loss.Chest radiography and computed tomography showed dextrocardia and right pulmonary hypoplasia.CONCLUSION This case presented a rare finding and an unusual association of 3 malformations,ipsilateral HFM,pulmonary agenesis,and dextrocardia.

Three-dimensional measurements on the mandible of patients with hemifacial microsomia

Background:Hemifacial microsomia(HFM),which involves multiple sites with different levels of severity,is the second most common congenital craniofacial deformity after cleft lip and palate.However,three-dimensional(3D)measurements of mandibular deformities have not yet been studied in detail.The objective of this study is to investigate the method of 3D measurements of mandibular deformities in HFM patients.Methods:A total of 48 HFM patients were included in this study.All clinical treatment for patients was performed in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences at Peking Union Medical College from June 2006 to June 2020.The patients’3D computerized tomography scan data were processed using medical imaging software,following four iterative steps:3D reconstruction,mirroring,differential analysis,and partition.Results:The characteristics of the mandibular bone in HFM patients are mainly presented as follows:(1)compared to the normal side,the part of the bone body that extends from the ascending ramus to the pogonion(Po-NB)is analyzed using a dynamic process:less fullness-fullness-more fullness;(2)absences were frequently observed among the angular zones,that is,the height of the ascending ramus is deficient.Conclusions:HFM is a complicated condition with numerous variations in clinical presentation.We employed both 3D image reconstruction and computerization image processing techniques to investigate asymmetrical mandibular deformity in HFM patients in detail and with great accuracy.This will be of great use to clinicians for disease management.

Fat Re-Grafting in Facial Asymmetry: A 2-Case Report

Fat redistribution through recycling of previously grafted fat hasn’t been reported. Two facial asymmetry patients are presented with history of fat grafting to the mandibular angle areas. Collected fat from these formerly fat grafted zones and swollen on subsequent extra body weight gain has been re-grafted in the temporal regions for contour enhancement and has retained volume as photographically documented up to 30 months.