Is this half face short?

summary

The treatment of hemifacial microsomia is a systematic project. First of all, even if early treatment has been carried out in childhood, there may be different degrees of deformities left in adulthood, which need further reduction. Secondly, due to limited conditions, patients who should be treated in the early stage without any treatment often have severe deformities and need staged surgical reconstruction. Thirdly, patients with mild deformities need to wait until adulthood to undergo surgery. In the face of this group of patients, we need to design personalized treatment plan according to the above-mentioned treatment principles of facial asymmetry.

Is this half face short?

The jaw is in the middle of the face or slightly deviates to the affected side. The occlusal relationship is normal and the jaw plane is basically horizontal. There is no obvious deviation of the jaw movement when opening and closing the mouth. In the choice of treatment scheme, the contour reconstruction method is mainly used. The common methods include: (1) reduction of zygomatic bone on the contralateral side, removal of mandibular outer plate and mandibular angle osteotomy on the contralateral side, (2) augmentation of zygomatic bone on the affected side, bone grafting or Medpor placement and filling on the affected side of mandible surface, (3) chin osteotomy and plastic surgery（ 4) Free facial fat transplantation.

It was characterized by dysplasia of the maxilla and mandible on the affected side, obvious asymmetry of both sides of the face, inclination of occlusal surface and obvious deviation of chin, and mandibular deviation of the affected side when opening and closing the mouth. Preoperative X-ray examination showed that if the mandible of the affected side was well developed and suitable for orthognathic surgery, Le Fort I osteotomy rotation of the maxilla, sagittal split osteotomy rotation of the mandible and chin osteotomy displacement could be used to correct the occlusal plane and straighten the central axis of the face. In the second stage, the external contour was further adjusted according to the above treatment methods. In general, the affected side of the face is still narrow, and the width of the face can be adjusted by bone grafting or Medpor placement. The problem of soft tissue dysplasia on the affected side can be corrected by autologous fat injection.

For patients with severe occlusal plane deviation, due to the traction limitation of adjacent soft tissue and the poor development of the affected ramus, it is often difficult to correct the deviation of the mandibular plane by simultaneous maxillary Le Fort I osteotomy and mandibular sagittal split osteotomy. Maxillary deformity and mandible can be one-stage distraction lengthening, but our clinical experience shows that the treatment of maxillary and mandible is divided into two stages, which can reduce the risk of surgery and improve the quality of life of patients during treatment. The mandible was lengthened in the first stage, and the maxillary Le Fort I osteotomy was performed in the second stage.

matters needing attention

Early treatment of mandibular deformity can prevent and reduce the formation and degree of secondary deformity, and promote the coordinated development of craniofacial skeleton. Early treatment, facial deformity is not complex, surgery is relatively simple, most patients can avoid adult larger, more complex surgery. Moreover, if we can correct the mandibular deformity before school age, so we are in the stage of mixed teeth. Through the self adjustment of permanent teeth eruption, we can better improve the jaw biting relationship. In addition, early treatment is also conducive to the psychological development of children, so that they can more freely integrate into social life.