Hemifacial Microsomia: Treatment

Early Non-Surgical Treatment:

Ears. If a child is born with an absent ear, which is called "microtia", then keeping the opposite functional eardrum healthy takes on an even greater importance. I recommend that parents who have a child with microtia to be on the lookout for any sign of an ear infection on the opposite side (it is not really possible to get an ear infection on the microtic side). Multiple ear infections on the unaffected side may diminish hearing; therefore, parents should have a low threshold for bringing their baby to the pediatrician (or pediatric ENT) to check for possible ear infections.

In general, the vast majority of children with microtia never need any hearing aids. It is important to have your child's hearing tested periodically. If both the ears are normal in size, but one side (or both) is prominent (sticks out), this condition may be treated non-surgically with molding wax, as long as treatment is begun in the first few weeks of life. After about 8 weeks of age, molding does not work because the ear cartilage attains "memory." See the ear reconstruction section for more information on ear reconstruction, or go to the Microtia Section.

Sleep apnea. It is also important to make sure that any child with hemifacial microsomia does not have sleep apnea. Children born with an absent TMJ (temporomandibular joint, or jaw joint) may have a "floppy" lower jaw that can shift backwards when the child is asleep at night, causing sleep apnea. If your child is a "noisy breather" at night, it is a good idea to get a sleep study to ensure your child is getting enough oxygen while asleep in order to continue to develop and learn normally. For some children, it is possible to use a special orthodontic device (a "Herbst appliance") to help prevent sleep apnea. Rarely, children may need to use a special mask (called CPAP or BiPAP units) while sleeping, which helps the child to get enough oxygen while sleeping. In general, sleep apnea is not common in hemifacial microsomia, but it is important to check for in children who are more severely affected.

Speech Evaluation. Some children with hemifacial microsomia may have an imbalance in the movement of the palate (roof of mouth), which on rare occasions may lead to abnormal speech. If any asymmetrical palatal motion is identified, then your child should be evaluated by a speech pathologist.