Hemifacial microsomia (HFM), also known as craniofacial microsomia or “Goldenhar syndrome,” is a disorder in which half of the face is undeveloped and does not grow properly. One side of the face is referred to as hemifacial. Microsomia is a term that refers to a lack of size.
The severity of hemifacial microsomia deformity varies widely from kid to child, as do the parts of the face that are afflicted. HFM, on the other hand, always includes some degree of lower jaw underdevelopment (mandible).
The following areas of the face may be underdeveloped in HFM:
- -both the outer and middle ear
- -the right side of the skull
- -tissue for the cheeks
- -Jaws, both upper and lower
- -some of the nerves that allow you to move your face
The extent to which different regions of the face are impacted varies, and others may not be affected at all.
Hemifacial microsomia necessitates specialized treatment from a multidisciplinary team that includes plastic and oral surgeons, dentists, and orthodontists, among others. Our craniofacial team at Boston Children’s includes world-renowned physicians who are experts in treating HFM.
What do the signs and symptoms of hemifacial microsomia look like?
The most evident indicators of hemifacial microsomia in children are underdeveloped upper and lower jaws on one side of the face. Your child’s mouth may appear to slope upward toward the affected side. On the affected side, the forehead and cheek are often flattened, and one eye socket is smaller than normal.
Other hemifacial microsomia symptoms include:
Small nodules of extra skin surrounding the ear, underdeveloped or absent external ear, underdeveloped or absent inner ear structures, and hearing loss are all examples of ear disorders.
A tiny or undeveloped jaw, an upward slanted mouth/jaw, the appearance of a “crooked smile,” and the inability to chew are all examples of jaw anomalies.
Flat cheeks and/or forehead, general facial asymmetry (unevenness), muscle weakness, and lack of sensation are some of the facial findings.
This disease can appear on both sides of the face in rare cases. Bilateral face microsomia is the medical term for this condition.
Hemifacial microsomia is caused by a combination of factors:
The exact causes of hemifacial microsomia are unknown. The illness is thought to be caused by a disruption in your baby’s fetal development during the first six weeks of pregnancy. It’s unclear whether environmental influences are at play.
Because the illness has been recorded to occur more than once in a family, hemifacial microsomia is assumed to be hereditary in some families. The genes that cause hemifacial microsomia have yet to be discovered.
Nothing you (or the other parent of your child) did — or did not do — caused the hemifacial microsomia.
How can you know if you have hemifacial microsomia?
The best expert to diagnose hemifacial microsomia is an experienced geneticist, who specializes in illnesses caused by genetic problems. Experts, on the other hand, do not agree that heredity is to blame for all cases of hemifacial microsomia. A physical examination of your child and a review of his or her medical history is usually enough for a geneticist to diagnose hemifacial microsomia.
Hemifacial microsomia does not have a single test, although numerous tests can be utilized to validate a diagnosis.
Among the diagnostic tests that could be used are:
Head X-rays are a type of X-ray that shows the inside of the skull.
A computed tomography (CT) scan is a type of imaging that uses a computer to create a three-
What are the options for dealing with hemifacial microsomia?
Hemifacial microsomia affects certain children more than others, necessitating additional surgeries and more care. The priorities in infancy are to make sure your kid is breathing and eating properly. The goal is to improve the appearance and function of the damaged areas later in childhood and adolescence.
We provide individual surgical treatment strategies for each patient. Your child’s treatment team will consist of a diverse group of experts from many fields. Each member of our craniofacial team will work together to develop a treatment plan that is tailored to your child’s individual needs.
The Boston Children’s Facial Reanimation Program treats facial nerve paralysis:
Children with facial nerve paralysis caused by HFM are treated by a team of doctors at Boston Children’s Hospital who have significant training and experience in restoring the highest possible degree of sensation and movement to a child’s face.
Lack of facial expression or facial muscle tone can cause a range of functional and social issues for your child, as our skilled, empathetic team understands. That is why we make it our business to provide the most up-to-date and effective therapies, such as:
- -Soft tissue transfer: We use soft tissue from other parts of the body to add volume to your child’s cheeks and forehead.
- -Dynamic muscle transfer: A muscle transfer from one body area to the face might improve facial expressions and function if your child lacks facial sensibility and motion.
- -Microsurgical procedures: Our doctors will use ways to reduce scars and shorten recovery times in order to diminish the negative effects of surgery.
- -Fillers: Artificial “fillers” can be used to add bulk to weak areas when your child is a pre-teen or teenager, when face growth is slowing off.
Taking Care of Jaw Problems:
The upper and/or lower jaws of most children with hemifacial microsomia are substantially underdeveloped. This can make chewing difficult as well as keeping the teeth in appropriate alignment. The course of treatment is determined by the severity of your child’s symptoms.
Reconstructive surgery can comprise the following procedures:
- -Distraction osteogenesis: This is a jaw lengthening technique in which the surgeon makes a cut in the jawbone and inserts a device that slowly stretches and lengthens the bone.
- -Bone graft: If your child’s jaw malformation is severe, surgeons may use bone and cartilage from other parts of the body to restore the underdeveloped area of his or her jaw.
Your child may experience some asymmetry (unevenness) in the appearance of the jaw after surgery, as well as problems eating and biting. To improve look and function, many surgical treatments may be required over a long period of time.