Hemifacial microsomia

Ideally, people with hemifacial microsomia should be managed by a team of specialists that work together. A qualified, craniofacial medical team can be found at a craniofacial center. Depending on the features and severity in the affected person, specialists involved in treatment may include:

• audiologist
• dietitian
• ophthalmologist (eye doctor)
• oral and maxillofacial surgeon (face, mouth and jaw surgeon)
• orthodontist to treat crowding of teeth
• orthopedist to assess spine issues
• otolaryngologist for any nose or throat issues
• dentist or pediatric dentist to assess dental health
• plastic and reconstructive surgeon
• speech pathologist to address speech problems
• psychologist or social worker to address social, emotional or psychological issues.^[1][2]

Other types of specialists may also be needed depending on the features present in each person.

Treatment of hemifacial microsomia varies depending on the features present and the severity in each affected person. Various types of surgeries may be needed in many cases.

Some children need breathing support or a tracheostomy soon after birth if the jaw is severely affected. However in most cases, airway problems can be managed without surgery. Those with a jaw deformity and/or clefts may have feeding problems and may need supplemental feedings through a nasogastric tube to support growth and weight gain. Babies born with cleft lip or palate can have surgical repairs done during the first year. Cleft lip repair is typically performed when the child is 3-6 months old, while cleft palate surgery is generally performed when the child is about a year old. A lateral facial cleft, one of the most severe abnormalities associated with the condition, also requires reconstruction in stages.

If eye closure is incomplete due to eyelid abnormalities or facial paralysis is present, a child may need eye protection or surgery. Surgery may also be used for eyelid differences to reposition the lower lids and corners of the eyes. Some children with abnormally shaped or missing ears may choose to have a series of reconstructive surgeries to make the ear appear more normal. Children with skin, cheek and other soft tissue deficiencies may need augmentation procedures such as fat grafting or tissue transfer. Severe bone abnormalities may require surgery as well.^[2]

Because multiple body systems may be involved in hemifacial microsomia, affected people should continually be monitored for complications.