Enoral distraction osteogenesis in hemifacial microsomia

Hemifacial microsomia is a combination of anomalies of the ear and the mandible. The condyle is the most affected part, but also the ascending and horizontal ramus, the glenoid fossa, the malar arch, maxilla and orbit can be included, depending on the severity of the malformation. According to these different grades of expression various treatment algorithm are required: Functional orthodontic treatment, distraction osteogenesis of the mandible, combined distraction osteogenesis of mandible and maxilla or transplants in cases where no distractable bone is present. Hemifacial microsomia may be associated with microphthalmia (Goldenhar syndrome). These patients require a combined treatment with distraction osteogenesis for lower jaw and midface and orbital expansion by means of tissue expanders to achieve a symmetrical result.