Facial Reconstruction in Adult Branchial Arch Disease Patients

Branchial arch diseases like the Treacher Collins syndrome (TCS) or Goldenhar syndrome (GHS) are seldom genetic disorders. They can be present as unilateral or bilateral alterations of the phenotype. With severity ranging from mild to severe, organs predominantly affected are the ears, eyes, cheekbones, palate, and mandible, resulting in deformities of different stages. Despite normal life expectancy, reconstructive facial surgery is usually required to improve the quality of life. In severe cases of mandibular dysgnathia with an underdeveloped mandible, a lifesaving tracheostomy may be necessary directly after birth. In adulthood, special focus is given to improving orofacial function and aesthetics. In these cases, one major surgical approach aims at distracting the mandible to a more anterior position to widen the laryngeal and pharyngeal space. Mild deformities of the midface and mandible are typically operated on between the age of 15 and 18 years, whereas moderate and severe deformities can be operated on earlier at the age of 5–10 years. A cleft palate is usually closed surgically at the age of 12 months. This chapter deals with reconstruction strategies in adulthood, aimed to restore form and function.