The Correction of Mild Hemifacial Microsomia: Polyethylene Implantation, Lateral Cortectomy, and Osseous Genioplasty

Hemifacial microsomia is a condition most frequently associated with facial asymmetry. Authors have experienced eighteen patients with mild hemifacial microsomia who were classified as type IA and IB. For the correction of mandibular asymmetry, mandibular augmentation was performed on the mandibular angle of the affected side using mandibule shaped porous high-density polyethylene(Medpor(R)) in thirteen patients. Reduction mandibuloplasty was performed on the mandibular angle of the normal side using lateral cortectomy in four patients, and genioplasties were used in 2 patients. Osseous genioplasty(n=10), buccal fat removal(n=4), augmentation rhinoplasty(n=2), and onlay bone graft(n=1) as ancillary procedures were simultaneously executed. Except for 4 patients in whom the implants were removed due to exposure and infection, all other patients were satisfied with a more symmetric contour of their face. The results were clinically evaluated through ordinary scale method and photogrammetric analysis. The mean score was rated 'good' as 12.5 points, and the mean bigonial distance index and the mean gonion-midsagittal distance index were 105.20%(p=0.035) and 100.65%(p=0.368), respectively, which meant a more symmetry of the lower face. In minor asymmetry of the mandible in cases of hemifacial microsomia, augmentation with cautions of the affected side, reduction with lateral cortectomy of the mandible in the non-affected side, and an even osseous genioplasty can provide the patient with a more symmetric lower face.

Reconstructions of Binder's Syndrome with Various Surgical Techniques: Photogrammetric Analysis of Nasomaxillary Bone

Binder's syndrome has some characteristic signs, such as orbital hypotelorism, shortened and flat noses, diminutive columella, crescent shaped nostrils, acute nasolabial angle, convex upper lip, class III malocclusion, absent anterior nasal spine, and maxillary hypoplasia. Binder's syndrome patients usually need the correction of the following three: the hypoplatic nose, the perialar flatness due to underdevelopment of the piriform margin, and the hypoplastic maxilla with its malocclusion. The authors treated eleven(n=14) patients through various surgical techniques depending on the clinical signs. In order to correct the nasomaxillary hypoplasia, the autogenous bones, the autogenous cartilages and the alloplastic implants were used. In three patients with severe nasomaxillary retrusion, the combined Le Fort I and II osteotomies and the perinasal osteotomy were performed. The results were analyzed using the proportion indices from the preoperative and postoperative lateral photographs of the patients. The postoperative values of all the proportion indices were significantly higher compared to the preoperative ones. For nasal dorsal augmentation, columellar lengthening and peripiriform augmentation, autogenous bone grafts were found to be very effective. The use of high-density porous polyethylene sheets for columellar lengthening was preferred over the use of nasal septal cartilages. Two types of osteotomy were the most effective for nasomaxillary augmentation in severe deformity.