PMC5544248_01
The 24-year-old female patient (case 4) was diagnosed with HFM (type I).. Her natural head position was inclined to the right to compensate for her chin deviation. She was treated using Le Fort I, bilateral sagittal split osteotomy, genioplasty, and mandibular angle reduction, without a second stage of fat injection. Her natural head position adjusted spontaneously after surgery.
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HFM (type I) on the right side of her face (Fig 5). Her natural head position was inclined to the right side to compensate for her chin deviation.
PMC5544248_02
The patient (Case 9, type IIA) was an 18-year-old female who underwent OGS consisting of LeFort I, bilateral sagittal split osteotomy and genioplasty, combined with right zygoma reduction.. 6 months postoperatively, soft-tissue augmentation for the deficient cheek using microautologous fat transplantation technique was performed with 47 ml of autologous fat. (Upper, before surgery; middle, after OGS; lower, after fat injection).
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The 18-year-old female patient was diagnosed with HFM (type IIA) affecting the left facial hemisphere from the middle to lower facial part (Fig 6).
3-dimensional cone-beam computed tomogram of the patient case 9 in Fig 6.. Preoperative image (left) showed facial bone deformity and asymmetry. The patient received two-jaw surgery, genioplasty, and right zygoma reduction (right).
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Pre- and postoperative 3D cone-beam CT showed the deformity and correction of the facial bones (Fig 7).
PMC5544248_03
A female patient with Type IIB hemifacial microsomia involving the left side of face (case 13).. She was followed up at 5 years of age (above left and middle). The panorex X-ray showed hypoplastic and inferiorly displaced condyle without adequate glenoid fossa. She was 7 years 9 months of age during the distraction osteogenesis (above right). Facial appearance was improved at 8 years 6 months of age (below left). Significant facial asymmetry was noted at 21 years 1 month of age (below middle). She received two stages of surgical correction. The facial appearance was improved at 22 years 2 months of age (below right).
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This patient had type IIB hemifacial microsomia (Fig 8). At 21 years of age, significant facial asymmetry was noted (Fig 8, lower middle). She was happy with the results (Fig 8, lower right).
Three-dimensional surgical simulation for the case 13.. Preoperative views were shown in the upper row. There was prominent asymmetry in the maxilla and mandible with occlusal canting. Part of the left zygomatic arch was missing. The ramus was short, but was thick after the previous distraction osteogenesis. The left condyle was hypoplastic and displaced inferiorly, medially and anteriorly. There was no proper glenoid fossa. The articulation was judged acceptable for orthognathic surgery. The surgical simulation and planning was shown in the lower row.
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Three-dimensional simulation was performed (Fig 9), and she underwent orthognathic surgery with LeFort I, bilateral sagittal split osteotomy, genioplasty, as well as mandibular angle and masseter muscle reduction on the right side.