EFFECT OF EARLY ORTHOPEDIC INTERVENTION ON HEMIFACIAL MICROSOMIA PATIENTS - AN APPROACH TO A COOPERATIVE EVALUATION OF TREATMENT RESULTS

The purpose of the present study was to analyze the effects of early o rthopedic intervention in patients with hemifacial microsomia, clinica lly as well as radiologically, by computed tomographic examination to assess soft and hard tissue temporomandibular joint changes. Five pati ents, one with mandibular dysostosis, one with otomandibular dysostosi s, two with Goldenhar syndrome; and one with a surgically revised fibr oma of the right mandible that was reconstructed by a costochondral gr aft, were treated by means of an activator functional appliance. Durin g functional appliance treatment, all patients showed improvement of f unction and occlusion, and facial asymmetry was reduced. Spiral comput ed tomographic examination before and during treatment provided data o n the bony and muscular deficiencies. The volume and density of the la teral pterygoid muscle was measured with the standard computed tomogra phy software. Evaluation of soft and hard tissue conditions before tre atment has shown that the most important factor ''lack of soft tissues '' can be compensated by excellent cooperation during functional thera py. Pretreatment volume of the affected lateral pterygoid muscle in al l patients was significantly smaller than on the unaffected side. In t hree patients, volume measurements between 4 and 8 years demonstrated that the lateral pterygoid muscle on;the affected side had a third, le ss than a third, and a fifth of the volume of the unaffected side. Alt hough increase, stability, and decrease of the ratio of left and right condylar dimension, muscular volume, and density were found, long-ter m prognosis cannot be given in the cases with extreme muscular deficie ncies after cessation of growth. Prepubertal orthopedic treatment succ ess is a desirable and feasible presurgical or nonsurgical treatment g oal for the interdisciplinary team approach. From a study of the patho logic, we learn much about the normal.