Hemifacial Microsomia:
Treatment:
The best treatment plan for a child with hemifacial microsomia depends
upon the severity of the condition. Some children, who are the most mildly
affected, might not need any treatment at all; whereas severely affected
children require more care. At the current time, there is some controversy
among craniofacial surgeons as to what is exactly the best treatment for
children with hemifacial microsomia (or craniofacial microsomia, or Goldenhar
variant).
Some doctors believe that treatment should begin at an earlier age,
and others believe it is best to wait until more growth has occurred.
Some doctors recommend distraction (placement of a metallic screw driven
device used to lengthen bones) and others believe this device should not
be used (see ,
Book Chapters, #1). The following reflects a personal approach to treating
this condition. Various surgeons will recommend different techniques;
hopefully this review will enable parents to ask their doctors better
questions to helping parents make the best decisions for their child.
This section will first cover non-surgical treatment early treatment,
then touch upon ear reconstruction, then finally give an overview of jaw
surgery.
Early
Non-surgical Treatment | Ear
Reconstruction | Jaws
Treatment Summary:
I believe it is best to be conservative when it comes to recommending
surgery. Most children with hemifacial microsomia are fairly mildly affected,
which means that while their faces are flatter on one side, and the chin
may not line up perfectly in the middle, they overall look just fine.
For these children, I prefer to wait until they are ready to proceed with
surgery and then to choose the smallest possible operation that will bring
about the biggest change. Sometimes, only a small outpatient procedure
to line up the chin is all that is necessary. In general, the fewer
major operations that are done, the better the child ends up looking as
an adult. It is important to discuss the specifics of any proposed
operation with your craniofacial surgeon to make sure that you understand
what is being done and why.
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