Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 148-162
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.148
Surgery-first for a patient with mild hemifacial microsomia: A case report and review of literature
Ji-Yu Song, Hua Yang, Xi He, Shuang Gao, Guo-Min Wu, Min Hu, Yi Zhang
Ji-Yu Song, Min Hu, Yi Zhang, Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun 130000, Jilin Province, China
Hua Yang, Department of General Dentistry, Hospital of Stomatology, Jilin University, Changchun 130000, Jilin Province, China
Xi He, Department of Prosthodontics, Hospital of Stomatology, Jilin University, Changchun 130000, Jilin Province, China
Shuang Gao, Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130000, Jilin Province, China
Guo-Min Wu, Plastic Aesthetic Center, Hospital of Stomatology, Jilin University, Changchun 130000, Jilin Province, China
Author contributions: Song JY and Zhang Y were the patient’s orthodontist, designed the orthodontic plan, reviewed the literature and contributed to manuscript drafting; Yang H reviewed the literature and contributed to manuscript drafting; He X was the patient’s prostheticist, was responsible for the patient cosmetic prosthetic, and contributed to manuscript drafting; Gao S was the patient’s endodontist; Wu GM was the patient’s orthognathic surgeon; Hu M revised the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81801005 and No. 81870795; and Jilin Provincial Development and Reform Commission, No. 2018-33-05.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Zhang, DDS, PhD, Doctor, Lecturer, Department of Orthodontics, Hospital of Stomatology, Jilin University, No. 1500 Qinghua Road, Chaoyang District, Changchun 130000, Jilin Province, China. zhangyi0519@jlu.edu.cn
Received: February 16, 2020
Peer-review started: February 16, 2020
First decision: September 29, 2020
Revised: October 12, 2020
Accepted: November 4, 2020
Article in press: November 4, 2020
Published online: January 6, 2021
Processing time: 319 Days and 13.9 Hours
Abstract
BACKGROUND

Hemifacial microsomia (HFM) is the second most common craniofacial congenital anomaly following cleft lip and palate. Because of the various phenotypic spectra and the severity of the deformity, a wide range of treatment approaches have been proposed. Recently, the surgery-first approach (SFA) was introduced to treat mild to moderate HFM, and it yielded a balanced facial appearance. The SFA not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

CASE SUMMARY

A female patient, aged 25 years old, sought orthodontic treatment with the chief complaint of dental and facial asymmetry. After a comprehensive physical examination and imaging analysis were performed, the patient was diagnosed with mild HFM that was primarily attributed to unilateral abnormal development of the maxilla-mandibular. The SFA was carried out to correct the skeletal deformity. The palatal suture was used as the midline of the maxilla in the surgical plan to center the maxilla, and the chin was also properly positioned to obtain a relatively symmetrical facial appearance. Four weeks after the surgery, the patient was referred for postsurgical orthodontics to decompensate the dentition and stabilize the occlusion. After 20 mo of treatment, all orthodontic appliances were removed. The posttreatment photographs of the patient and her smile confirmed good aesthetic and occlusal results.

CONCLUSION

Mild HFM can be corrected by SFA, which not only promotes rapid improvement in facial aesthetics but also considerably reduces the overall treatment time.

Keywords: Hemifacial microsomia; Skeletal deformity; Surgery-first approach; Orthodontics; Orthognathics; Case report

Core Tip: Hemifacial microsomia (HFM) is the second most common craniofacial congenital anomaly following cleft lip and palate. Recently, the surgery-first approach (SFA) was introduced to treat mild to moderate HFM, promote rapid improvement in facial aesthetics and reduce the overall treatment time. When presurgical orthodontics information on the underlying skeletal deformity is not available, careful treatment planning and strong collaborations between skilled orthodontists and surgeons are needed to predict accurately surgical skeletal movement and postsurgical tooth movement after SFA. This case report presents a successful SFA in a patient with mild HFM. The treatment outcome confirmed a balanced facial appearance.