FUNCTIONAL THERAPY IN HEMIFACIAL MICROSOMIA - THERAPEUTIC PROTOCOL FOR GROWING CHILDREN

Purpose: This study evaluates the skeletal response to functional orth odontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatmen t is also suggested. Materials and Methods: Sixteen growing children w ith unilateral HM were treated. Each patient was graded according to t he skeletal, auricular, tissue (SAT) classification. Patients graded S -4-S-5 were excluded because the severity of the malformation made the m unsuitable for functional orthodontic treatment. All patients initia lly underwent a period of treatment with an asymmetrical functional ac tivator (AFA). Results: In 7 of 16 cases (43.7%) classified as S-1-S-2 /T-1, regardless of the value of A, functional therapy brought about m andibular growth greater on the side of the malformation (G(3)-G(4)), re-establishing structural and functional harmony of the entire stomat ognatic apparatus. Of the five cases (31.2%) classified as S-2/T-2, fo ur required surgical intervention at about 10 years of age after an in itial period of functional therapy that produced mandibular growth cla ssified G(1)-G(2). In the other case, functional treatment was suffici ent to correct the malformation. In four patients (25%) classified as S-3/T-3 or S-3/T-2, it was necessary to combine surgical treatment wit h functional therapy. Conclusion: Use of the AFA in growing children w ith HM makes it possible to induce harmonious maxillomandibular growth . Statistically, in S-1-S-2/T-2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe case s (S-2/T-2), it needs to be combined with orthodontics using fixed app liances and surgical intervention.