One-stage reconstruction of the temporomandibular joint in hemifacial microsomia.

In some patients with hemifacial microsomia, the mandibular ascending ramus and condyle are absent. Sometimes the zygomatic arch and glenoid fossa are also absent, and the zygoma and lateral orbital wall are deficient and misplaced. Complete alignment of the facial skeleton with construction of all components of the temporomandibular joint has been performed as a one-stage procedure on 14 patients, aged 6 to 23 years. The principle "first the bone, rarely the soft tissue" has evolved because when the skeleton is correct, the soft tissues assume a normal contour. The dangers of major skeletal surgery in children can be minimized if patients are referred to major craniofacial centers.