J Med Assoc Thai 2011; 94 (12):100

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Craniofacial Microsomia: Goals of Treatment, Staged Reconstruction and Long-Term Outcome
Chowchuen B Mail, Pisek P , Chowchuen P , Thanaviratananich S

Background: Craniofacial microsomia (CFM) is a complex congenital condition and includes a spectrum of malformations primarily involving structures derived from the first and second branchial arches.
Objective: to present a review of the clinical presentations, assessment, treatment and outcome of the patients with CFM who were treated by the authors in Srinagarind hospital, Khon Kaen University.
Material and Method: Medical records were reviewed of patients with CFM, seen and managed by the authors at Srinagarind Hospital between 1993 and 2011; for an analysis of the clinical and radiologic assessments, treatments and outcomes.
Results: There were 23 patients (14 males and 9 females), 4 of whom had bilateral deformities, 19 unilateral deformities, and 1 syndromic CFM. The clinical presentation ranged from microtia to more severe deformities involving the mandible, zygoma and maxilla. Surgical treatments included: correction of macrostomia, distraction osteogenesis, staged ear reconstruction, orbit-maxillary-mandibular surgery, soft tissue reconstruction with dermis fat graft, vascularized free tissue transfer, cleft lip-cleft lip nose repair and palatoplasty. Most of the patients were satisfied with the medical treatment and many patients were still in the growing skeletal age and had staged reconstruction planned.
Conclusion: The goals of treatment for CFM are to (a) manage respiratory insufficiency and feeding problems (b) maximize hearing and communication (c) improve facial symmetry and proper facial growth and (d) optimize dental occlusion. These patients require staged reconstruction and coordinated care by an experienced multidisciplinary craniofacial team in order to ensure a thorough, comprehensive assessment of the nature and extent of the problems and to provide better treatment planning and long-term outcome adapted to the respective anatomic and functional deformities of each patient, and the needs of their family and other involved stakeholders.

Keywords: Craniofacial microsomia, Goals of treatment, Staged reconstruction, Long-term outcome

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