title: True hemifacial microsomia and hemimandibular hypoplasia with condylar-coronoid collapse: diagnostic and prognostic differences.
abstract: BACKGROUND
  Long-term results after orthopedic or surgical treatment of hemifacial microsomia (HFM) have shown a tendency toward recurrence of the facial asymmetry. However, the literature contains a number of successful case reports that show surprising changes in the morphology of the condyles. In addition, patients with similar mandibular asymmetries, treated early with surgery, have excellent long-term follow-ups, especially those who have little or no soft-tissue involvement, but only severe mandibular ramal deformities. The phenotypes of these cases are unexpectedly similar, with a consistent collapse of the condyle against the coronoid and a deep sigmoid notch. The objectives of this article were to help distinguish true HFM from this peculiar type of hemimandibular asymmetry morphologically and to quantify their differences before treatement and in the long term.
  
  
  METHODS
  Panoramic radiographs taken at pretreatment and the long-term follow-up of 9 patients with hemimandibular hypoplasia, characterized by the collapse of the condyle against the coronoid, were compared with those of 8 patients with severe type I and type II HFM; these records were collected before and at least 10 years after distraction osteogenesis.
  
  
  RESULTS
  Ratios and angular measurements before and after treatment differed significantly between the 2 groups.
  
  
  CONCLUSIONS
  Perhaps these patients were misdiagnosed and actually had secondary injuries of the condyle, which have a normal functional matrix. Therefore, with growth and functional stimulation, they would tend to grow toward the original symmetry. To make a differential diagnosis between true HFM and this peculiar type of hemimandibular hypoplasia, the collaboration between not only orthodontists and surgeons, but also geneticists and dysmorphologists, is of great importance because of the different prognoses.
authors.affiliation: Department of Maxillofacial Surgery, Cleft Lip and Palate Center, University of Milano, Milan, Italy. cmeazzini@yahoo.it
authors.forename: Maria C
authors.initials: MC
authors.lastname: Meazzini
authors.forename: Roberto
authors.initials: R
authors.lastname: Brusati
authors.forename: Alberto
authors.initials: A
authors.lastname: Caprioglio
authors.forename: Patrik
authors.initials: P
authors.lastname: Diner
authors.forename: Giovanna
authors.initials: G
authors.lastname: Garattini
authors.forename: Ennio
authors.initials: E
authors.lastname: Giannì
authors.forename: Faustina
authors.initials: F
authors.lastname: Lalatta
authors.forename: Carlo
authors.initials: C
authors.lastname: Poggio
authors.forename: Enrico
authors.initials: E
authors.lastname: Sesenna
authors.forename: Alessandro
authors.initials: A
authors.lastname: Silvestri
authors.forename: Catherine
authors.initials: C
authors.lastname: Tomat
mesh_terms: D002508:Cephalometry / Q000379:methods; D003937:Diagnosis, Differential; D005146:Facial Asymmetry / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000002:abnormalities* / Q000601:surgery; D008335:Mandibular Condyle / Q000002:abnormalities* / Q000601:surgery; D009971:Orthodontics, Corrective; D019857:Osteogenesis, Distraction / Q000379:methods; D010641:Phenotype; D011379:Prognosis; D011862:Radiography, Panoramic; D016896:Treatment Outcome