What is hemifacial microsomia?
Hemifacial microsomia is a subset of craniofacial microsomia. It is a spectrum of undergrowth conditions or malformations related to the craniofacial skeleton. They occur in 1 in 3,000 to 25,000 live births, second only to the incidence of cleft lip and palate. The lower jaw (or, mandibular) deformity is the most common manifestation of the disease process. In fact, the severity is classified on the basis of the lower jaw deformity (Pruzansky classification).
The underlying problem is an underdevelopment of the craniofacial skeleton, including the external, middle, and inner ear structures as well as the jaw and overlying soft tissue structures (including the cranial nerves). As its name suggests, it usually occurs only on one side of the face (ie, hemifacial or unilateral). The occurrence of this condition is largely unknown.
- What is hemifacial microsomia?
- Why does hemifacial microsomia occur?
- What are the associated problems with hemifacial microsomia?
- Can hemifacial microsomia be inherited?
- How is hemifacial microsomia treated?
- What is the recovery from Hemifacial Microsomia like?
- What are the risks and complications of Hemifacial Microsomia?
What is the recovery from Hemifacial Microsomia like?
Recovery from surgical correction of each component of hemifacial microsomia is highly variable. Whereas ear reconstruction can potentially be performed as an outpatient, other aggressive interventions such as jaw surgery and facial reanimation may require a brief hospitalization. Considerations must be made for airway management when operating on the jaws or inside the mouth.
Generally, avoidance of aggressive play and close supervision is required for the first 2 to 4 weeks following surgery. This restriction will need to be tailored to the procedure performed and is directly proportional to the aggressiveness of the intervention.
Jaw or oral procedures will usually have dietary restrictions (soft diet only) for 6 weeks following surgery. All procedures require some level of scar management. The plastic surgeon should guide patients at every step.
Risks and Complications
What are the risks and complications of Hemifacial Microsomia?
All procedures for correcting individual deformities related to hemifacial microsomia will carry a different set of risks and potential complications. Thankfully, all procedures are relatively safe when appropriate preoperative evaluation is performed. Airway complications are the most serious issue encountered. Anesthesia pre-evaluation is necessary to stratify risk and to make provisions at the time of surgery for successful intubation and postoperative management. Many of the risks encountered during surgery for hemifacial microsomia are directly proportional to the severity of the condition. For example, airway obstruction carries a higher likelihood of occurring when the lower jaw is extremely small (ie, Pruzansky III classification) and shifted than when it is only slightly small (ie, Pruzansky I classification).
Bleeding, infection, and anesthetic complications are risks of any surgical procedure. In addition, poor scarring or wound problems can occur rarely. More frequently, achieving perfect symmetry is an impossibility. Improvements can be substantial, but reversing the deformity to a normal state cannot be realized in the majority of patients. Overcorrection or undercorrection may occur. Injected fat may resorb and incompletely correct a contour deficit. Many times, revisional surgery will be required to improve scars, contour, or symmetry, as mentioned above.
Why choose Dr Panossian
- He received his medical education at Tufts University School of Medicine.
- Graduated at the top of his class at UCLA, receiving Phi Beta Kappa and Summa Cum Laude honors.
- Was accepted into an elite combined general surgery and plastic surgery residency at the Keck School of Medicine of USC.
- Completed subspecialty training in craniofacial surgery at the Hospital for Sick Children in Toronto and Harvard Medical School.
- Was mentored by Dr. Ron Zuker in the practice of facial paralysis reconstruction. This prestigious fellowship position was available to only one surgeon in the United States.
- Is affiliated with various charitable and educational organizations, including Operation Smile and Mending Kids.
- Is a member of the American Society of Plastic Surgeons and the highly selective American Association of Plastic Surgeons, reserved for only a select group of individuals nationally who have demonstrated excellence in academic plastic surgery.
- Holds memberships in several other professional societies including the American College of Surgeons and the American Society of Reconstructive Microsurgery.
- He serves on the Board of Directors for Mending Kids and the Gondobay Manga Foundation, a non-profit organization dedicated to the improvement of lives in Sierra Leone.
- Has been nominated by his peers annually since 2012 as a “Super Doctor.”
- Served as an expert medical consultant and appeared on The Doctors, Grey’s Anatomy, and Nip/Tuck.
- Has been featured as “Top Doctor” in US News and World Report, Pasadena Magazine, and Los Angeles Magazine.
Last modified by Dr. Andre Panossian