| Objective:It is expected to summarize the methods and experience of the 6 patients in this paper hoping for contributing to the diagnosis and treatment of Pruzansky III Hemifacial Microsomia(HFM)in the future.Contents and methods:A total of 6 patients with Pruzansky III HFM who received treatment in the Maxillofacial Plastic Center of Plastic Surgery Hospital,Chinese Academy of Medical Sciences from 2012 to 2017.The effects of free grafts with autogenous costae-costicartilage and vascularized autogenous fibula on the treatment of HFM were evaluated.Results:(1)Among the 6 patients,the 3 patients receiving the autologous costae-costicartilage recovered well,achieved the healing by first intention and discharged on time.Treatment outcome was satisfactory.One child gave up the orthodontic treatment due to fear of pain and the other two patients showed operation cooperation.(2)All the 3 patients receiving free grafts of autologous vascularized fibula had good and free leg movement.The first case completed the clinical treatment smoothly.The second case suffered infection 7 day after surgery,and delayed wound healing after rinsing and dressing for 1 month.The third case suffered hematoma 24 hours after surgery.The second-stage exploratory operation found venous thrombosis without any chance for kissing bounds again.After removing the hematoma,it was changed to free grafts of non-vascularized fibula.The postoperative healing was good for the patient who discharged on time and returned to the local hospital for orthodontic treatment.(3)For the patients receiving the free grafts with autogenous costae-costicartilage,the postoperative images obtained in the follow-up visit indicated good survival of the costae-costicartilage with stable position and reasonable direction and length.Part of the costae was absorbed,the length variation was limited and the volume was reduced.(4)For the patients receiving the free grafts with autogenous fibula,the fibula absorption was still obvious and the absorption of the length was a prominent challenge.The positions and directions of the grafts were good,and the healing of the bone stumps and the grafts was satisfactory.Conclusions:After reviewing the 6 patients with Pruzansky ? HFM,and analyzing the experience and lessons of the treatment process,we believe that the free grafts with autogenous costae-costicartilage and fibula are safe and effective and should be used as the preferred method for the reconstruction of the temporomandibular joint and its ascending branch in the treatment of Pruzansky ? HFM.However,in the specific therapy,there are many problems and details waiting for us to find a solution. |
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