Hemifacial microsomia, also known as craniofacial microsomia or first and second branchial arch syndrome, is a congenital condition in which the tissues on one side of the face are underdeveloped. Surgical techniques used in the treatment of this condition include distraction osteogenesis and bone grafting to rebuild the jaw or ear.
The pediatric plastic surgery and craniofacial teams at The Children's Hospital of Philadelphia are among the most experienced in the world in caring for children with hemifacial microsomia. Watch this video to learn more about the treatment options available.
What is hemifacial microsomia?
Scott Bartlett, MD: So hemifacial microsomia, which is also known as craniofacial microsomia, or first and second branchial arch syndrome, is the second most common condition of the head and neck in children, after cleft lip and palate.
We don’t know what causes it, but what happens is an underdevelopment of one side of the face. And up to 20% of the patients, this can be both sides of the face. We have varying deficiencies of the soft tissue and bone, which can include the ear, the lower jaw, the upper jaw, the soft tissue and the nervous structure. And it varies from being very mild to even almost complete absence of those structures.
So hemifacial microsomia is typically diagnosed at birth. So the treatment of hemifacial microsomia depends on the degree of the difference, as well as the age of the child. In children that have less severe deformities, frequently it’s a matter of just taking the existing bone structure and cutting it and shifting it, or elongating it. Or doing a procedure called distraction where we actually cut the bone, pull it apart, and create new bone.
And then we do things to the soft tissue like adding soft tissue from elsewhere, such as fat grafts and fat transfers. All of which are done to normalize the appearance and improve the facial symmetry.
In some children that have a very severe manifestation of the disease, such as an absence of the bone of the jaw, or an absence of the ear, then we have to rebuild that. And we do that with bone grafts taken from the rib or from the lower leg to build the jaw. And to rebuild the ear, taking cartilage from the rib to carve a new ear.
One of the things that we’ve worked on recently, when some of these children are born with a severe deformity, is to use surgical planning using 3D images that we take of the children. We can actually manipulate them with the computer, so that we get a virtual image ahead of time of what the child is going to look like and what we can do, and what we should do, to add to make that deficient mandible, or jaw, the most normal.
So children with hemifacial microsomia, a certain of them may have an increase incident of associated anomalies such as cardiac condition, spine condition, limb condition. So we work close with orthopedic, with cardiology, with cardiac surgery, hand surgery, to address all of those needs concurrently. Some of the children that are more severely effected with hemifacial microsomia may require respiratory support. They may not be able to breathe at birth, and sometimes during childhood, because the lower jaw structure that supports the breathing apparatus, such as the tongue, is not fully developed.
We work closely with our neonatologist as well as our Neonatal Craniofacial Program to make sure, and our neonatal airway program, to make sure that those children get the respiratory support they need. Every patient is individual, and our team will develop an individual treatment plan to address every one of the major areas of deficiency or deformity in hemifacial microsomia with the best possible outcome.
Topics Covered: Hemifacial Microsomia