Craniofacial Microsomia: Goals of Treatment, Staged Reconstruction and Long-Term Outcome
Bowornsilp Chowchuen MD, MBA*, Poonsak Pisek DDS**, Prathana Chowchuen MD***, Sanguansak Thanaviratananich MD****
Affiliation : * Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand *** Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand **** Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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
