Surgical treatment of hemifacial microsomia. (First and second branchial arch syndrome).

A review of 17 patients operated upon for unilateral hemifacial microsomia, and followed for up to 18 years, clarifies several principles of management. The management is facilitated by dysplasia predominance grouping, with the major functional deformity dictating the sequence of repair. Our surgical goals are: (1) provision of adequate upper airway; (2) preservation of normal teeth and adequate alveolar bone to achieve proper dental occlusion; (3) restoration of binaural hearing; (4) external ear construction; (5) acceptable facial symmetry; (6) balanced facial animation; and (7) a child with an acceptable self-image.