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Information on Hemifacial Microsomia (Goldenhar)

Hemifacial microsomia is a congenital malformation that affects structures derived from the 1st and 2nd embryonic branchial arches. Its features may be more or less severe, depending on each affected individual. The main affected structures are the external ear, the adenexal region, the mouth and the eyes for the soft tissues and the zygomatic, maxillary, temporal and mandibular bones.

The staging of surgical interventions is usually as follows:

External ear, cheek/soft tissue deformities, ear tags, macrostomia (large mouth), epibulbar dermo´ds, cleft palate are all defects not seen on every patient that are corrected early in life.

Cleft palate: 10-12 months (if necessary)
External ear: 6 years or more (if necessary)
Gleno´d fossa, condyle and ascending ramus of the inferior maxillary: 5 to 10 years (if necessary)
Orbital / zygomatic complex reconstruction with cranial grafts = 6 to 9 years of age (if necessary)
Orthognatic surgery (jaw surgery): 14-16 years (usually necessary - must be preceded and followed by orthodontic treatment)
Rhinoplasty (nose surgery): 15-17 years (if necessary)

Robert Paquin, D.M.D.
Senior Resident, Oral and Maxillofacial Surgery
Laval University,
Quebec City, Canada

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