Surgery of Hemifacial Hypertrophic States (Facial Asymmetries)

Facial overgrowth states, based on an alteration in size, form, and spatial and functional relationships of the viscero-cranial complex, can lead to progressive changes and compensations that affect jaw and tooth positions. One-sided alterations of growth lead to facial asymmetries. As the underlying course of overgrowth states resembles the underlying biology and extent of anatomy that of facial under-developments (in an accelerated and not decreased growth), diseases can be categorized as branchial arch complex malformations. Various terms are used confusingly in the literature. Patients with defined syndromal overgrowth (e.g., Beckwith–Wiedemann syndrome) must be distinguished from syndrome-like overgrowth patients (e.g., hemifacial hyperplasia/hypertrophy and hemimandibular hyperplasia) and isolated overgrowth situations. Surgery is required for hemifacial overgrowth states to normalize the facial asymmetry, which is often combined with a disturbed muscular balance and/or impaired jaw, speech, or masticatory functions. Most cases are treated with various orthognathic procedures, including condylectomy procedures. The surgical strategy differs for the different subgroups of overgrowth syndromes. A surgical protocol for a definitive facial symmetry correction in hemifacial overgrowth states is presented and discussed.