What is hemifacial microsomia? 

Hemifacial microsomia is a congenital disease that occurs at birth. It occurs when a portion of one side of your face does not grow normally. That can happen on both sides of your face. Also known as craniofacial microsomia, oculo-auriculo-vertebral spectrum, or oculoauricular dysplasia. 

Hemifacial microsomia can cause problems with your: 

-> Cheekbones 

-> Facial nerves 

-> Eyes 

-> The lower jaw 

-> Muscles and the Neck 

Other physiological systems, bones, and soft tissues, such as your heart, kidneys, ribs, and spine, are rarely affected by hemifacial microsomia.

 

Is hemifacial microsomia common? 

After cleft lip and palate, it is the second most frequent facial deformity. 

 

Causes and Symptoms 

What are the signs of hemifacial microsomia? 

The symptoms vary depending on whatever part of your face is affected:

 

Ears 

-Inadequate ear placement. 

-Loss of hearing. 

-An ear canal is missing. 

-Tags on the skin. 

-An outer ear that is small or lacking (microtia). 

 

Eyes 

-Inability to close one eye completely. 

-One eye is missing. 

-Noncancerous tumors (epibulbar dermoids). 

-Little eye. 

-Vision issues. 

 

Face 

-Flattened brow or cheek. 

-Paralysis caused by nerve problems (facial palsy). 

-Minimal facial muscles. 

-Cleft lip or palate in the mouth. 

-Difficulties communicating, swallowing, or eating. 

-Small jaw. 

-A little aperture in the mouth or tongue. 

-Uneven grin caused by muscular and nerve problems. 

-Large mouth. 

 

Respiratory system

-Breathing difficulties 

 

Teeth 

-Teeth with unusual shapes. 

-Tooth development delays. 

-Additional or missing teeth. 

-Disaligned upper and lower teeth (malocclusion).

 

 

Testing and Diagnose 

What are the symptoms of hemifacial microsomia? 

Typically, a physical exam and imaging examinations are all that is required for diagnosis. In some circumstances, healthcare workers use prenatal ultrasound to detect indicators of the illness before delivery. 

 

Further imaging investigations performed after birth aid in determining the severity. 

 

These are some examples: 

- X-rays are used to evaluate tissue and bone structures. 

- MRI to provide more thorough examinations of tissue and bones. 

- CT scan to reveal the most detail, including organ and muscle anomalies. 

 

Will my child require any extra tests? 

Additional tests that your child's doctor may order include: 

- Echocardiogram to rule out any cardiac problems. 

- Renal ultrasonography for kidney evaluation. 

- A spine X-ray to ensure proper bone alignment.

 

 

Treatment and Management 

Is it possible to treat hemifacial microsomia? 

 

Surgery is frequently required to restore or remodel face features. The nature and timing of these operations are determined by your child's need. As your child grows, it is often necessary to postpone operations or conduct them in phases. 

 

Surgical procedures include: 

 

• Maxillofacial or craniofacial surgery 

 

The following operations may be performed on your child's jaw: 

 

-Move your child's upper or lower jaw forward so that their teeth line up when they bite down. 

-Lengthening: Making their jaw wider so that their mouth is wider and more functional. 

-Reconstruction: The process of recreating pieces of a person's jaw using rib tissue or a man-made device. 

-Repair of cleft lip and palate.

 

 

• Oral surgery 

 

These methods are as follows: 

 

-Tooth extractions to alleviate overcrowding and severe alignment problems. 

-Dental implants are used to replace missing or removed teeth. 

 

 

• ENT surgery (ear, nose, and throat) 

 

Otolaryngologists (ear, nose, and throat surgeons) conduct the following procedures: 

 

-Installing a hearing device (cochlear implant) or adjacent bones in your youngster. 

-Rebuilding a missing ear or improving the appearance of a little one.

 

 

 

• Surgery on the eyes 

 

Ophthalmologists carry out a variety of procedures, which may include: 

 

-Making an eye socket and inserting an artificial eye. 

-Increasing the size of a small eye socket. 

-Removing harmless growths. 

-Repositioning your child's lower lid and corner of the eye, allowing their eye to properly close when blinking. 

 

 

• Cosmetic surgery 

 

Plastic surgeons improve face characteristics by doing the following: 

 

-Reconstruction of soft tissue and bone to restore face symmetry. 

-Facial reanimation surgery to restore/optimize face movement and improve facial symmetry.

 

 

What treatments can my baby require after birth? 

Treatment is required promptly after birth in severe situations. These are some examples: 

 

-Tracheostomy: A breathing incision in your child's neck and windpipe. 

-Tube feeding: If your child is unable to accept nutrients orally. 

 

What nonsurgical therapies could my child require? 

Nonsurgical treatments may include the following: 

 

-Braces and other tooth-straightening appliances. 

-Hearing aids for people with slight hearing loss. 

-Speech therapy to treat swallowing and speaking difficulties.

 

 

Prevention 

Is there anything I could have done to prevent my child's hemifacial microsomia? 

No. Experts are still attempting to figure out what is causing this disease. However, research indicates that it is not the outcome of situations that occurred or did not occur during pregnancy. 

 

 

Prognosis / Outlook 

What is the outlook for children suffering from hemifacial microsomia? 

In most cases, the ailment has little effect on life expectancy. A child born with this condition should expect to live around the same amount of time as a person without it. 

 

Nonetheless, hemifacial microsomia can have an impact on quality of life. As children get older, they will have to deal with the difficulties that come with being different. Even with successful procedures, tasks that are easy for other children, such as eating, talking, or sleeping, may be challenging for this child.

 

 

What is it like to have hemifacial microsomia? 

 

Children with this illness require continuing medical treatment, which may include many procedures. Yet, until they reach early adulthood, they are unlikely to require any further treatments. Long-term monitoring may be required to detect abnormalities that reoccur or worsen over time. Epibulbar dermoids may reappear. Hearing aids and implants might need to be adjusted. 

 

Physical difficulties as well as the psychological repercussions of looking different might have an impact on your child's emotional health. Getting aid through counseling is critical in assisting your child in developing coping mechanisms.

 

 

Recmed Medical’s summary on Hemifacial microsomia

Hemifacial microsomia occurs when one side of the face fails to develop normally. It can impair your child's ability to eat, see, hear, and breathe, among other things. They can, however, enjoy a long and productive life. Surgery is frequently required to correct physical differences and maximize functioning. Counseling can assist your child in dealing with emotional and social difficulties.

 

References:

• Ear Community. Hemifacial Microsomia/Craniofacial Microsomia. (https://earcommunity.org/microtiaatresia/associated-conditionssyndromes/hemifacial-microsomia/) Accessed 4/19/2022.
• Facial Palsy UK. Hemifacial Microsomia. (https://www.facialpalsy.org.uk/causesanddiagnoses/hemifacial-microsomia/) Accessed 4/19/2022.
• Foundation for Faces of Children. Hemifacial Microsomia (HFM). (https://facesofchildren.org/glossary/hemifacial-microsomia-hfm/) Accessed 4/19/2022.
• Khetani MA, Collett BR, Speltz ML, Werler MM. Health-related quality of life in children with hemifacial microsomia: parent and child perspectives. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4218728/) J Dev Behav Pediatr. 2013;34(9):661-668. Accessed 4/19/2022.
• NIH Genetic and Rare Diseases Information Center. Hemifacial Microsomia. (https://rarediseases.info.nih.gov/diseases/6582/hemifacial-microsomia) Accessed 4/19/2022.

 

 

By Recmed Medical - Micro Surgeons & Advanced Aesthetic Reconstruction Doctors