Kearns G J, Padwa B L, Mulliken J B, Kaban L B
Craniofacial Centre at Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Plast Reconstr Surg. 2000 Feb;105(2):492-8. doi: 10.1097/00006534-200002000-00002.
Hemifacial microsomia is a common craniofacial anomaly, variably affecting structures derived from the first and second pharyngeal arches. Correction of the skeletal deformity in children has been advocated to improve growth potential and reduce secondary deformity. However, contrary reports have suggested that facial asymmetry in hemifacial microsomia does not increase with growth; therefore, skeletal correction can be postponed, even until adolescence. The purpose of this study was to test the hypothesis that facial asymmetry in hemifacial microsomia is progressive. This is a retrospective evaluation of 67 patients with untreated hemifacial microsomia. The patients were categorized as: group I (mandible type I, IIa), n = 38, and group II (mandible type IIb, III), n = 29. Pretreatment posterior-anterior cephalometric radiographs were used to analyze asymmetry by measuring the angle between the true horizontal and the following planes: piriform rim, maxillary occlusal plane, and intergonial angle. Angular measurements were averaged for patients in the deciduous (<6 years), mixed (> or =6<13 years), and permanent dentition (> or =13 years). In group I, angle piriform rim, maxillary occlusal plane, and intergonial angle increased from 7.0, 4.3, and 4.4 to 8.4, 6.6, and 6.1 degrees, respectively [mean age, 4.1 (deciduous) to 8.6 (mixed) to 21.0 (permanent) years]. In group II, angle piriform rim, maxillary occlusal plane, and intergonial angle increased from 9.5, 6.2, and 5.3 to 11.7, 7.6, and 8.0 degrees, respectively [mean age, 3.4 (deciduous) to 8.0 (mixed) years]. These data demonstrate that hemifacial microsomia is progressive and underscores the importance of early surgical correction of mandibular asymmetry in this disorder.
半侧颜面短小畸形是一种常见的颅面畸形，会不同程度地影响源自第一和第二咽弓的结构。有人主张对儿童的骨骼畸形进行矫正，以提高生长潜力并减少继发畸形。然而，相反的报告表明，半侧颜面短小畸形的面部不对称并不会随着生长而加剧；因此，骨骼矫正可以推迟，甚至推迟到青春期。本研究的目的是检验半侧颜面短小畸形的面部不对称是进行性的这一假设。这是一项对67例未经治疗的半侧颜面短小畸形患者的回顾性评估。患者被分为：I组（下颌骨I型、IIa型），n = 38，以及II组（下颌骨IIb型、III型），n = 29。通过测量真正的水平线与以下平面之间的角度，利用治疗前的后前位头颅侧位X线片分析不对称情况：梨状孔边缘、上颌咬合平面和下颌角间角。对乳牙期（<6岁）、混合牙列期（≥6<13岁）和恒牙列期（≥13岁）的患者的角度测量值进行平均。在I组中，梨状孔边缘角、上颌咬合平面角和下颌角间角分别从7.0°、4.3°和4.4°增加到8.4°、6.6°和6.1°[平均年龄，从4.1岁（乳牙期）到8.6岁（混合牙列期）再到21.0岁（恒牙列期）]。在II组中，梨状孔边缘角、上颌咬合平面角和下颌角间角分别从9.5°、6.2°和5.3°增加到11.7°、7.6°和8.0°[平均年龄，从3.4岁（乳牙期）到8.0岁（混合牙列期）]。这些数据表明半侧颜面短小畸形是进行性的，并强调了在这种疾病中早期手术矫正下颌不对称的重要性。
