Hemifacial Microsomia

All faces are inherently asymmetric but severe asymmetry may be the result of hemifacial microsomia (HFM).  HFM can be associated with orbit (eye socket), ear (microtia)  and jaw malformations (mandible) as well as facial nerve palsy (facial droop). Weakness in the smile on the affected side may also be seen.  Branchial clefts or remnants as well as kidney abnormalities may also be commonly associated. Surgical treatment is aimed at each involved structure, typically beginning with removal of remnants after the age of 6 months. Jaw and soft tissue abnormalities may be deferred until your child has reached school-age, around the age of five, to allow for facial growth.

OMENS classification

• Microtia (small or absent ear)
• Mandible Malformations
  • Type 1 – vertical shortening of mandible, normal TMJ.    Treatment orthodontics, mandible surgery (BSSO or distraction)
  • Type 2
  • Type 3 – complete absence of TMJ

Treatment around age 5: Rib Graft followed by mandibular distraction  or free fibula bone graft

Soft tissue asymmteries  are often treated by fat grafting

Asymmetries due to nerve palsy can be treated by Botox to the nerves on the normal side