title: Restoration of facial symmetry in hemifacial microsomia with mandibular outer cortex bone grafting combined with distraction osteogenesis.
abstract: BACKGROUND
  Mandibular distraction is a well-established method of correcting facial asymmetry in hemifacial microsomia. However, asymmetry in lower facial width remains after distraction because of its inability to increase bone thickness. Therefore, the authors used mandibular outer cortex bone grafting to augment the lower face following distraction to restore facial symmetry.
  
  
  METHODS
  From January of 1997 to December of 2007, 21 patients with hemifacial microsomia underwent unilateral mandibular distraction followed by mandibular augmentation using mandibular outer cortex bone graft harvested from the normal side. Age at surgery ranged from 7 to 27 years. Facial symmetry was evaluated based on medical photography and radiography with a minimum 6-month follow-up.
  
  
  RESULTS
  Mandibular height and length were expanded successfully with distraction, resulting in improvements in chin position and oral commissure level. Lower facial width was increased on the affected side and reduced on the normal side after bone grafting. Thus, three-dimensional facial symmetry was significantly improved in all patients. Long-term follow-up showed no evidence of relapse. The majority of the patients were satisfied with the reconstructive outcome.
  
  
  CONCLUSIONS
  Mandibular augmentation with bone grafts harvested from the contralateral outer cortex effectively addressed the asymmetry in lower facial width that was uncorrected by distraction alone, achieving three-dimensional restoration of facial symmetry in hemifacial microsomia.
authors.affiliation: Beijing, People's Republic of China From the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College.
authors.forename: Lai
authors.initials: L
authors.lastname: Gui
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Mengqing
authors.initials: M
authors.lastname: Zang
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Feng
authors.initials: F
authors.lastname: Niu
authors.forename: Bing
authors.initials: B
authors.lastname: Yu
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Tang
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Liu
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.forename: Wuyuan
authors.initials: W
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005146:Facial Asymmetry / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006053:Goldenhar Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008334:Mandible / Q000637:transplantation*; D019857:Osteogenesis, Distraction / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult