Long term Outcomes of Craniofacial Microsomia Treatment: Mandibular Reconstruction
Rachel Mandelbaum, BA, Deborah Martins, BA, Gina Farias-Eisner, MD, Roop Gill, MBBS, James P. Bradley, MD, Justine C. Lee, MD, PhD.
University of California Los Angeles, Los Angeles, CA, USA.
Mandibular hypoplasia is a defining characteristic of craniofacial microsomia. In this work, we review a single institution experience of the treatment and outcomes of mandibular reconstruction.
Craniofacial microsomia patients actively treated at the UCLA Craniofacial Clinic (n=151) between 2008-2014 were reviewed for mandibular treatment and outcomes. Patients greater than 14 years of age at the time of study initiation were included (n=42, average age of 18.3 years).
83.3% of patients had mandibular hypoplasia, of which 22.9% were bilateral, 40.0% were on the right, and 37.1% were on the left. 58.1% of mandibles were Pruzansky I, 20.9% Pruzansky IIA, 7.0% Pruzansky IIB, and 14.0% Pruzansky III. Facial nerve dysfunction was normal to mild in greater than 80% of the patients. 22.9% of patients required tracheostomy or early distraction for airway compromise. 40.0% of patients underwent an average of 4.14 mandibular surgeries with the initial surgery at a mean age of 9.9 years. 31.1% of patients required distraction, 7.1% required rib graft, and 19.0% underwent orthognathic surgery. In a linear regression model, age, higher Pruzansky score, airway compromise, or simultaneous microtia reconstruction did not predict increased number of mandibular surgeries, reoperation, or relapse. Facial nerve involvement was significantly associated with a greater number of surgeries performed (p=.039).
Mandibular reconstruction in craniofacial microsomia patients is a multi-stage procedure. Increased operations but not risk of complications were associated to the severity of the constellation of clinical presentation in craniofacial microsomia.
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