Craniofacial microsomia (CFM) encompasses a broad spectrum of phenotypes. It is thought to result from defective development of the first and second pharyngeal arch structures, and generally presents with anomalies of the mandible and other facial bones, ears, and overlying soft tissues. The cause of CFM is thought to involve both extrinsic and genetic risk factors. Several classification systems have been developed to help stratify patients based on the severity of their defects. Treatment of patients includes repair of bony asymmetry as well as soft tissue defects and auricular anomalies. Surgical intervention is individualized based on each patient’s deficits.
Key points
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There are several classification systems for craniofacial microsomia that group patients based on their degree of asymmetry. The most recent and comprehensive of these is the OMENS PLUS (Orbit, Mandible, Ear, Nerve, Soft tissue) system.
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Treatment of craniofacial microsomia is based on the severity of the deformity.
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Timing of surgical repair remains controversial.
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Mandibular distraction osteogenesis is a well-accepted method of correction of mandibular asymmetry but there is evidence of relapse if patients undergo distraction before completion of growth.
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Treatment includes not only correction of skeletal deformities but also soft tissue deficits (by means of free tissue flaps, fat grafting, and implants).
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