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Editorial Plastic and Aesthetic Research

Hemifacial microsomia: management of the

vertical ramus compartment

Maurice Yves Mommaerts

European Face Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Address for correspondence: Prof. Maurice Yves Mommaerts, European Face Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101,
1090 Brussels, Belgium. E-mail: maurice.mommaerts@uzbrussel.be

ABSTRACT
Hemifacial microsomia and Goldenhar syndrome pose unique challenges to the craniofacial surgeon.
The O.M.E.N.S. classification provides a description of the craniofacial features. For the “M” of
O.M.E.N.S. (the mandible), the Pruzansky-Kaban classification provides therapeutic guidelines for
joint and face reconstruction. A sequence of standard procedures, including temporomandibular joint
reconstruction, facial rotation surgery, gluteal fat grafting, and patient-specific titanium implantation,
each have their intricacies. The author provides his expert opinion, acquired over thirty years of
experience, with an emphasis on descriptions of and solutions for ten problematic issues.
Key words:
Congenital abnormalities, goldenhar syndrome, mandibular reconstruction

INTRODUCTION From the mid-1970s to the mid-1990s, treatment
modalities for Type I and Iia Pruzansky-Kaban mandibular
Hemifacial microsomia is the second most common facial deformities included orthognathic treatment during
[5]
birth disorder, with a prevalence of one in 3,500-6,000 adolescence or “functional” orthodontic appliances
live births. In 70% of individuals, the condition is and early mandibular osteotomies to keep pace with the
[1]
[6]
unilateral [Figure 1]. The “O.M.E.N.S.” acronym is the rate of vertical midfacial growth. For Type IIb and III
most commonly used way to categorize hemifacial deformities in growing children, joint reconstruction with
microsomia. This acronym stands for orbital, mandibular, costochondral grafting was indicated. In the mid-1990s,
ear, facial nerve, and soft tissue deficiencies, which are early distraction osteogenesis, before skeletal maturation
rated on a scale of 0-3, according to their severity. and/or permanent dentition, was believed to induce
[2]
Most striking upon clinical examination are the external the formation of not only bone, but also of soft tissue.
[7]
ear deformities [Figure 2] and the facial asymmetry. However, a study published in 2002 and a systematic
[8]
The latter is related to deficiencies in the vertical review published in 2009 concluded that there are no
ramus compartment, originating from both skeletal long-term benefits to early osteodistraction in the vertical
tissues (mandible and skull base) and soft tissues ramus.
(muscles of mastication and subcutaneous fat) [Figure 3]. The aim of this article was to explain the author’s protocol
The mandibular deformity, considered separately from for the reconstruction of the vertical ramus compartment
the skull base (temporal bone and orbit) deformities, has in hemifacial microsomia, highlighting the key issues of
been classified by Pruzansky and Kabanas Type I to III [3,4] the technique. All patients involved in this article agreed to
[Figures 4-7]. publish their facial pictures and signed the consent form.
KEY ASPECTS OF SURGERY
Access this article online
Quick Response Code: To illustrate the author’s treatment strategy for a
Website: deficiency of the vertical ramus compartment, 10 salient
www.parjournal.net
points are presented with illustrative photographs
from a series of patients. The general approach for
DOI: the different Pruzansky-Kaban types is presented in
10.4103/2347-9264.157097 Table 1. Orbito-zygomatic and jaw angle reconstructions
are performed in all types of hemifacial microsomia

Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015 99