How is hemifacial microsomia treated?
The Craniofacial Center at Children's Colorado will perform a thorough evaluation of your child. Your child may also see other specialists to better diagnose and treat his or her particular condition(s). Together we will create a comprehensive treatment plan for your child.
The main concerns in the early treatment planning for children with hemifacial microsomia have to do with vision, breathing and hearing. Not all children with hemifacial microsomia will have each of these problems.
Vision and eye function will be assessed by an ophthalmologist. Ointments may be used in the eyes, particularly when sleeping, to protect the corneas. The orbit and zygoma (cheekbone) may need to be reconstructed with bone grafts or implants. The timing of this type of surgery is determined by the severity and presentation of your child's symptoms. If there are no functional concerns regarding the orbit, this operation is usually done after the age of 7, when the growth of the midface is nearly complete.
The small jaw that is often associated with hemifacial microsomia may contribute to breathing and eating problems. Positioning, special feeding devices or tubes may help with these issues. If the symptoms are severe enough, a procedure to lengthen the mandible (lower jaw) may be recommended. Some children with difficulty breathing will require a tracheostomy. Some children with a particular type of lower jaw deformity may be candidates for a bone graft to lengthen the mandible. This is usually done between 6-12 years of age. Orthognathic jaw surgery may be recommended in late adolescence.
If your child has a cleft palate, surgical correction may be undertaken between 9-18 months. Speech therapy may also be necessary.
An audiologist and an otolaryngologist will evaluate your child for hearing problems and to make recommendations regarding the need for hearing assistive devices. Abnormalities of the external ear may be addressed, if necessary, when the child has completed approximately 80% of ear growth. Correction may be undertaken in a staged approach with separate surgeries beginning after the age of 6. An alternative to this is the creation of a prosthetic ear.