Comprehensive consideration and design with the virtual surgical planning-assisted treatment for hemifacial microsomia in adult patients

https://doi.org/10.1016/j.jcms.2018.05.004Get rights and content

Abstract

Purpose

Hemifacial microsomia (HFM) is a frequently encountered congenital malformation syndrome involving both hard and soft tissue. Various surgical methods have been described to correct the deformities of HFM in the literature. This study aims to evaluate the therapeutic efficacy for HFM with the assistance of virtual surgical planning (VSP) and 3-dimensionally printed surgical templates.

Materials and methods

From January 2010 to January 2016, a total of 46 patients were referred to the study. Different surgical procedures under the guidance of VSP and 3-dimensionally printed surgical templates combined with orthodontic treatment were used to correct the deformities. Clinical outcomes were evaluated by comparing the differences of affected-side ramus height, occlusal cant degrees and chin point deviation between the preoperative VSP and postoperative surgical results.

Results

Satisfactory facial contour and occlusion were achieved with the combination of orthognathic and orthodontic treatment. Postoperative examination results showed that VSP was accurately transferred into actual surgery. The difference between the preoperative design and the postoperative outcome was not statistically significant.

Conclusion

VSP and 3-dimensionally printed surgical templates serve as a reliable method and show great value in improving the accuracy and efficacy of surgical treatment of HFM.

Introduction

Hemifacial microsomia (HFM), also called the syndrome of the first and second branchial arch (Rollnick et al., 1987), is the second most common facial deformity after cleft lip and palate and affects approximately 1 in 5,000 births (Poswillo, 1974, Alfi et al., 2014). HFM's obvious maxillofacial characteristics include mandibular hypoplasia and unilateral or bilateral microtia with or without other facial deformities (Stark and Saunders, 1962, Obwegeser and Obwegeser, 2010). Morphologic as well as functional disturbances such as temporomandibular joint (TMJ) dysfunction, malocclusion and facial asymmetry can also be observed in HFM patients.

In order to have a consensus on the diagnosis and treatment of this disease, the Kaban modification of the Pruzansky's mandibular classification has traditionally been used (Leonard et al., 1988). Typically, HFM treatment requires a multi-disciplinary approach and long-term intervention. Different surgical approaches have been applied for the treatment of maxillofacial malformation, such as orthognathic surgery, distraction osteogenesis (DO) (McCarthy et al., 1992, Triaca et al., 2000, Sant'Anna et al., 2015), soft tissue augmentation such as high-density porous polyethylene (Medpor®) (Semergidis et al., 1996, Mohammad et al., 2010), and vascularized free flap transplant (Harrison and Quillen, 1983, Cobb et al., 2013).

To rehabilitate normal morphology and restore facial symmetry, preoperative surgical planning and simulation is particularly essential. In the past, surgical procedures depended mainly on conventional surgical models and surgeons' clinical experience instead of quantitative analysis. With the development of computer-assisted virtual surgical planning (VSP) and 3-dimensional (3D) printing techniques, a more proper and accurate choice for complex HFM treatment is now available to surgeons. VSP has enabled surgeons to make an accurate diagnosis, has guided accurate surgical execution, and has facilitated the analysis of postoperative tissue changes (Caloss et al., 2007, Zinser et al., 2013, Stokbro et al., 2014, Zhang et al., 2016). The aim of this retrospective study was to evaluate the functional, esthetic and occlusal outcomes of computer-assisted VSP in HFM. Furthermore, the accuracy of VSP in different surgical techniques was investigated.

Section snippets

Patients and procedures

From January 2010 to January 2016, a total of 46 adult HFM patients (21 female and 25 male (age range 19–32 years, follow-up range 12 weeks–16 months)) were treated in our hospital. All of them were categorized as Pruzansky-Kaban type I (10 patients) or type II (19 patients IIa, 17 patients IIb). Nearly all patients presented with facial deformities including micrognathia, occlusal plane canting, chin point deviation, ramus height deficiency, shortened mandibular body on the affected side and

Results

All patients were discharged after 5–7 days of hospital stay with no signs of infection. Nineteen patients underwent conventional orthognathic surgery such as Le Fort I osteotomy, unilateral or bilateral SSRO or inverted L osteotomy and DO was used in 17 patients. In order to correct the deficiency of soft tissue, 10 patients accepted conventional orthognathic surgery as well as high-density porous polyethylene implantation or a vascularized vastus lateralis flap transplant. Follow-up from 12

Discussion

HFM is one of the most common congenital deformities, with various maxillofacial clinical features such as short ramus, deviated chin and ear malformation (Stark and Saunders, 1962, Monahan et al., 2001, Obwegeser and Obwegeser, 2010, Ongkosuwito et al., 2013). Other designations include necrotic facial dysplasia, first and second branchial arch syndrome and Goldenhar syndrome (Murray et al., 1984; Rollnick et al., 1987). HFM has attracted more and more attention for its high incidence rate.

Conclusion

Our study has demonstrated the value of virtual surgical planning and 3D-printed surgical templates in improving accuracy and efficacy in the treatment of adult HFM patients.

Conflict of interest

None of the authors has any conflicts of interest.

Author contributions

Peng Wang, MD, PhD: analysis and drafting the article and critical revision for important intellectual content; Yu Wang, DDS, PhD: analysis and interpretation of data; Zhen Zhang, DDS, PhD: acquisition of data, drafting of the article; Xiang Li, DDS, PhD: critical revision of the article for important intellectual content; Bin Ye, MD, PhD: critical revision of the article for important intellectual content; Jihua Li MD, PhD: conception and design of the study, acquisition of data, final

Human subject protection

Institutional Review Board approval was granted for this study. The guidelines in the Declaration of Helsinki were followed at all points during this study.

Acknowledgements

This study was supported by the Natural Science Foundation of China (81470720, 31271032).

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