Reconstructive surgery of the soft tissue in hemifacial microsomia]

Hypoplasia of soft tissues constitutes one of the major elements of hemifacial microsomia. Despite the fact that it occurs in 95% of cases of microsomia, hypoplasia is one aspect of the syndrome that is often neglected. The authors, by a general review of the relevant literature, describe the quantitative and qualitative importance of hypoplasia, as well as its statistical rapport with other elements of the syndrome. In studying the different treatments available for hypoplasia of soft tissues, several factors stand out. New techniques of bone distraction have transformed surgical indications by allowing an extension of soft tissues, particularly of skin. The treatment of hypoplasia follows two major axes; firstly, the use of grafts by injection of adiposal tissue for cases in which the deficit is only moderate, and secondly, microsurgical flaps, mainly of the fasciocutaneous type, for the relatively small portion of cases (9%) in which the deficit is more severe. By first analysing any constraints due to the treatment of bone and ear malformations, the schedule of the different stages of necessary surgery can be effectively planned.