Hemifacial microsomia

Hemifacial microsomia
Synonyms Goldenhar Syndrome
Bilateral (both sides) hemifacial microsomia in an adolescent
Classification and external resources
Specialty craniofacial surgery, pediatrics
ICD-10 Q90
ICD-9-CM 758.0
OMIM 164210
MeSH D006053

Hemifacial microsomia (HFM) is a congenital disorder that affects the development of the lower half of the face, most commonly the ears, the mouth and the mandible. It usually occurs on one side of the face, but both sides are sometimes affected. If severe, it may result in difficulties in breathing due to obstruction of the trachea — sometimes even requiring a tracheotomy. With an incidence in the range of 1:3500 to 1:4500, it is the second most common birth defect of the face, after cleft lip and cleft palate. HFM shares many similarities with Treacher Collins syndrome.

Other names

The condition is also known by various other names:

Cause

The condition develops in the fetus at approximately 4 weeks gestational age, when some form of vascular problem such as blood clotting leads to insufficient blood supply to the face. This can be caused by physical trauma, though there is some evidence of it being hereditary . This restricts the developmental ability of that area of the face. Currently there are no definitive reasons for the development of the condition.

Severity

The clinical presentation of HFM is quite variable. The severity may depend on the extent of the area with an insufficient blood supply in utero, and the gestational age of the fetus at which this occurs. In some people, the only physical manifestation may be a small and underdeveloped external ear. In more severe cases, multiple parts of the face may be affected. Some people with HFM may have sensorineural hearing loss and decreased visual acuity or even blindness.

Goldenhar syndrome can be thought of as a particularly severe form of HFM, in which extracranial anomalies are present to some extent. Some of the internal organs (especially the heart, kidneys, and lungs) may be underdeveloped, or in some cases even absent altogether. The affected organs are typically on the same side as the affected facial features, but bilateral involvement occurs in approximately 10% of cases. Deformities of the vertebral column such as scoliosis may also be observed in Goldenhar syndrome.

While there is no universally accepted grading scale, the OMENS scale (standing for Orbital, Mandible, Ear, Nerves and Soft tissue) was developed to help describe the heterogeneous phenotype that makes up this sequence or syndrome.

Intellectual disability is not typically seen in people with HFM.

Classification

Figueroa and Pruzanksky classified HFM patients into three different types:[1]

Treatment

Depending upon the treatment required, it is sometimes most appropriate to wait until later in life for a surgical remedy – the childhood growth of the face may highlight or increase the symptoms. When surgery is required, particularly when there is a severe disfiguration of the jaw, it is common to use a rib graft to help correct the shape.

According to literature, HFM patients can be treated with various treatment options such functional therapy with an appliance, distraction osteogenesis, or costochondral graft. The treatment is based on the type of severity for these patients. According to Pruzanksky's classification, if the patient has moderate to severe symptoms, than surgery is preferred. If patient has mild symptoms, than a functional appliance is generally used.[2]

Patients can also benefit from a Bone Anchored Hearing Aid (BAHA).

References

  1. ↑ Figueroa, AA; Pruzansky, S (1982). "The external ear, mandible and other components of hemifacial microsomia". Journal of Maxillofacial Surgery. 10 (4): 200–11. doi:10.1016/S0301-0503(82)80042-8. PMID 6961179.
  2. ↑ Hansen, PR (1999). "Orthodontic management of the patient undergoing mandibular distraction osteogenesis.". Seminar in Orthodontics. PMID 10371937.
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