FACIAL ASYMMETRY HEMIFACIAL MICROSOMIA GROWTH CENTRE TRANSPLANTATION - DR SM BALAJI

This is a case of 9-year old girl child affected with hemifacial microsomia. She had earlier undergone surgical correction for macrostomia and ear tags earlier. Currently, with the disease progression, she has a retruded mandible and facial asymmetry over the right side of face. Currently, there is no effective treatment to stop the emaciation process. A CT-scan revealed a hypoplastic condyle over the right side. The best intervention that can be done is growth center transplantation. This would help to correct the hypoplastic mandibular condyle. Hence reconstruction of the condyle using costochondral graft was planned. Costochondral graft was harvested from the 6th rib. An intact perichondrium is required to ensure post-transplantation growth of the graft. The graft is harvested ensuring sufficient amount of tissue from costochondral junction. While performing the graft harvesting care should be taken to preserve the pleural tissue so that puncture of lung tissues does not happen. Through a submandibular incision, on the right half of the mandible, layerwise dissection was performed. During dissection, the rudimentary masseter was identified. The pterygomasseteric sling was incised and access to bone made after incision of the periosteum. The bone was prepared to receive the graft. A pull wire was passed along the lower border of the mandible at the angle region and the mandible pulled downwards. The cartilage side of graft was positioned into the glenoid fossa and secured to the posterior border of the ramus using screws and layerwise closure done.