Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation.

Abstract

This study aimed to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult patients with hemifacial microsomia (HFM). Six adults with HFM (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial computed tomography scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry. At T1, no significant differences were observed in skeletal movements compared with planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. After personalized implantation (T3), further significant improvements were observed in skeletal symmetry. Combining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult patients with HFM, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.