Abstract

Orthodontic Treatment in HFM: How To Minimize Care Burden

by Meazzini Maria Costanza

Introduction: Long-term results after orthopedic or surgical treatment of hemifacial microsomia (HFM) have shown a recurrence of the facial asymmetry. However, the literature contains several successful case reports that show surprising changes in the morphology of the condyles after functional appliances (FA) or distraction osteogenesis (DO). The phenotypes of these cases are unexpectedly similar, with a consistent collapse of the condyle against the coronoid and a deep sigmoid notch and no muscular hypoplasia on the affected side. The objectives of this paper are to help distinguish true HFM from this peculiar type of hemimandibular asymmetry morphologically and to quantify their differences before treatment and in the long term. Methods: Panoramic radiographs taken at pre-treatment and the long-term follow-up of 17 patients with hemimandibular hypoplasia, characterized by the collapse of the condyle against the coronoid, 8 of which treated with DO and 9 with FA, were compared with those of 10 patients with type II HFM treated with DO; these records were collected before and at least 10 years after DO or FA . Results: Ratios and angular measurements before and after treatment differed significantly between the 2 groups. Conclusions: these patients seem to be misdiagnosed secondary injuries of the condyle, which have a normal functional matrix. Therefore, with growth and functional stimulation, 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.

Learning Objectives

After this lecture, you will be able to differential diagnosis between congenital and acquired mandibular asymmetries
After this lecture, you will be able to know the effects of functional therapy in CFM
After this lecture, you will be able to know the effects of distraction therapy in CFM