title: Parry-Romberg reconstruction: optimal timing for hard and soft tissue procedures.
abstract: For the treatment of Parry-Romberg syndrome or progressive hemifacial atrophy, we studied 3 controversial issues: (1) optimal timing, (2) need for skeletal reconstruction, and (3) need for soft tissue (medial canthus/lacrimal duct) reconstruction. Patients with Parry-Romberg syndrome (>5 y follow-up) were divided into 2 groups: (1) younger than 14 years and (2) 14 years or older (n = 43). Sex, age, severity of deformity, number of procedures, operative times, and augmentation fat volumes were recorded. Physician and patient satisfaction surveys (5-point scale) were obtained, preoperative and postoperative three-dimensional computed tomographic scans were reviewed, and a digital three-dimensional photogrammetry system was used to determine volume retention. Our results indicate that the younger patient group required more procedures compared with the older patient group (4.3 versus 2.8); however, the younger group had higher patient/family satisfaction scores (3.8 versus 3.0). Skeletal and soft tissue reconstruction resulted in improved symmetry score (60% preoperatively to 93% final) and satisfaction scores (3.4 preoperatively to 3.8 final). Patients with Parry-Romberg syndrome required multiple corrective surgeries but showed improvements even when beginning before puberty. Soft and hard tissue reconstruction was beneficial.
authors.affiliation: Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California-Los Angeles, CA 90095, USA.
authors.forename: Ginger C
authors.initials: GC
authors.lastname: Slack
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Tabit
authors.forename: Karam A
authors.initials: KA
authors.lastname: Allam
authors.forename: Henry K
authors.initials: HK
authors.lastname: Kawamoto
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000367:Age Factors; D016025:Bone Transplantation / Q000379:methods; D004954:Esthetics; D005143:Eyelids / Q000601:surgery; D005145:Face / Q000601:surgery*; D005147:Facial Bones / Q000601:surgery*; D005150:Facial Hemiatrophy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007765:Lacrimal Apparatus / Q000601:surgery; D008297:Male; D008445:Maxillofacial Development / Q000502:physiology; D061646:Operative Time; D056948:Orthognathic Surgical Procedures / Q000379:methods; D010027:Osteotomy / Q000379:methods; D017060:Patient Satisfaction; D010780:Photogrammetry / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome