Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of congenital hemifacial microsomia. Clinical history notable for [unilateral/bilateral] hypoplasia of the [mandibular/zygomatic/orbital] complex. Onset noted at birth with progressive asymmetry during craniofacial growth. No reported history of associated cardiac, renal, or vertebral anomalies. Current concerns include [aesthetic deformity/malocclusion/auditory impairment/soft tissue deficiency].
Clinical Examination Findings
Physical examination reveals [Grade I-IV] Pruzansky-Kaban classification of mandibular hypoplasia. Soft tissue assessment demonstrates [ipsilateral/contralateral] atrophy of the masseter and temporalis muscles. Ocular findings include [orbital dystopia/epibulbar dermoid]. Auricular examination confirms [microtia/anotia/preauricular tags/atresia of the external auditory canal]. Cranial nerve VII function is [intact/impaired].
Treatment Protocol
Treatment plan involves a multidisciplinary approach. Surgical intervention options include: 1) Distraction osteogenesis for mandibular elongation. 2) Autologous fat grafting or dermal fillers for soft tissue augmentation. 3) Orthognathic surgery for occlusal correction. 4) Auricular reconstruction (rib cartilage graft or porous polyethylene implant). 5) Referral to audiology for bone-anchored hearing aid (BAHA) evaluation.