Hemifacial Microsomia:

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 publications, 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.

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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