Hemifacial Microsomia

What is hemifacial microsomia?

Hemifacial microsomia is a condition that's present at birth. It occurs when part of one side of your face doesn’t develop as it should. Sometimes it occurs on both sides of your face. The condition may also be called craniofacial microsomia, oculo-auriculo-vertebral spectrum or oculoauricular dysplasia.

Hemifacial microsomia can affect your:

• Cheekbones.
• Eyes.
• Facial nerves.
• Lower jaw.
• Muscles.
• Neck.

Rarely, hemifacial microsomia involves other body systems, bones and soft tissues, like your heart, kidneys, ribs and spine.

How common is hemifacial microsomia?

It’s the second most common facial abnormality after cleft lip and palate.

What are hemifacial microsomia symptoms?

Symptoms depend on which part of your face it affects:

Ears

• Abnormal ear positioning.
• Hearing loss.
• Missing ear canal.
• Skin tags.
• Small or missing outer ear (microtia).

Eyes

• Inability to fully close one eye.
• Missing eye.
• Noncancerous growths (epibulbar dermoids).
• Small eye.
• Vision problems.

Face

• Flattened forehead or cheek.
• Paralysis due to nerve issues (facial palsy).
• Small facial muscles.

Mouth

• Cleft lip or palate.
• Difficulty speaking, swallowing or eating.
• Narrow jaw.
• Small mouth opening or tongue.
• Uneven smile due to muscle and nerve issues.
• Wide mouth.

Respiratory system

• Difficulty breathing.

Teeth

• Abnormally shaped teeth.
• Delays in tooth development.
• Extra or missing teeth.
• Upper and lower teeth that don't align (malocclusion).

How is hemifacial microsomia diagnosed?

A physical exam and imaging studies are typically all that are necessary for diagnosis. In some cases, healthcare providers detect signs of the condition before birth using prenatal ultrasound.

Additional imaging studies after birth help determine the severity. These include:

• X-ray to assess tissue and bone structures.
• MRI to provide more detailed assessments of tissue and bones.
• CT scan to show the highest level of detail, including abnormalities in organs and muscles.

Will my child need additional tests?

Other tests your child’s healthcare provider may recommend include:

• Echocardiogram to check for heart issues.
• Renal ultrasound to assess the kidneys.
• Spine X-ray to check bone alignment.

Can hemifacial microsomia be fixed?

Surgery is often necessary to repair or reconstruct facial features. The type and timing of these procedures depend on your child’s needs. It’s often necessary to delay procedures or perform them in multiple stages as your child grows.

What types of surgery help children with hemifacial microsomia?

Care for children with hemifacial microsomia may include:

Craniofacial or maxillofacial surgery

These procedures are for your child's jaw and may include:

• Advancement: Moving your child's upper or lower jaw forward so that teeth line up when they bite down.
• Lengthening: Creating a broader jaw so that their mouth is wider and more functional.
• Reconstruction: Using rib tissue or a human-made device to recreate parts of their jaw.
• Cleft lip and palate repair.

Dental surgery

These procedures include:

• Tooth extractions to relieve overcrowding and severe alignment issues.
• Dental implants to take the place of missing or extracted teeth.

Ear, nose and throat surgery

Procedures that otolaryngologists (ear, nose and throat surgeons) perform include:

• Placing a hearing device in your child's inner ear (cochlear implant) or nearby bones.
• Reconstructing a missing ear or enhancing the appearance of a small one.

Eye surgery

Ophthalmologists perform a range of procedures that may include:

• Creating an eye socket and implanting an artificial eye.
• Enlarging a small eye socket.
• Removing benign growths.
• Repositioning the lower lid and corner of your child's eye, making it possible for their eye to fully close when blinking.

Plastic surgery

Plastic surgeons enhance facial features by:

• Soft tissue and bone reconstruction to restore facial symmetry.
• Facial reanimation surgery to improve facial symmetry and restore/optimize facial movement.

What treatments might my child need after birth?

In severe cases, treatments are necessary immediately after birth. These include:

• Tracheostomy: An incision in your child's neck and windpipe to aid breathing.
• Tube feeding: If your child cannot take nutrition by mouth.

What nonsurgical treatments might my child need?

Nonsurgical therapies may include:

• Braces and other teeth-straightening devices.
• Hearing aids for mild hearing loss.
• Speech therapy to address challenges with swallowing and speaking.

Is there anything I could have done to prevent hemifacial microsomia in my child?

No. Scientists are still trying to determine what causes this condition. But research shows that it isn't the result of circumstances that did or did not occur during pregnancy.

What is the prognosis for children with hemifacial microsomia?

In most cases, the condition doesn't limit life expectancy. A child born with this condition can expect to live about as long as a child without it.

But hemifacial microsomia can affect quality of life. As children get older, they'll have to cope with the challenges of looking different. Tasks that are easy for other children, like eating, talking or sleeping, may be difficult even with successful surgeries.

What’s living with hemifacial microsomia like?

Children with this condition need ongoing medical care, including multiple surgeries. But once they reach early adulthood, they likely won’t need any more procedures. Long-term follow-up may be necessary to check for issues that come back or worsen over time. Epibulbar dermoids can return. Hearing aids and implants may need adjusting.

Physical challenges and the psychological effects of looking different can impact your child’s emotional health. Seeking support through counseling is essential in helping your child develop coping strategies.

A note from Cleveland Clinic

Hemifacial microsomia occurs when one side of the face doesn’t develop as it should. It can affect your child’s ability to eat, see, hear, breathe and more. But they can still live a long, productive life. Surgery is often necessary to repair physical differences and maximize functioning. Counseling can help your child cope with emotional and social challenges.