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Objective: To study the combination of Mandibular distraction and orthognathic techniques for the reconstruction of adult hemifacial microsomia., Methods: The three-dimensional CT reconstruction data was used with Mimics for preoperation design. The osteotomy location, distraction vector, distraction distance were decided before operation with a surgical guider. At the first stage, internal distractor was implanted after ostetomy through an extra-oral approach. The distraction begun 5-7 days after operation with a frequency of 1 mm/day. After distraction, the distractor was maintained for 3-6 months. At the second stage, the distractor was removed. Le Fort I osteotomy was performed in order to correct the cross-bite and improve the facial contour. Usually, bone graft was inserted into the gap after Le Fort I osteotomy. The genioplasty was also performed if necessary., Results: 9 cases of adult hemifacial microsomia with severe mandibular deviation were treated. The facial asymmetry were improved greatly. 1 patient suffered an wound infection in the maxillary region after Le Fort I osteotomy and healed uneventfully with wound irrigation., Conclusions: Mandibular distraction combined with orthognathic surgery is an effective procedure for adult hemifacial microsomia with complicated mandibular hypoplasia.

Objective: To sum up the various procedures for skeleton and soft tissue contour reconstruction in severe progressive hemifacial atrophy., Methods: From Jan 2004 to May 2012, 25 patients with severe progressive hemifacial atrophy underwent the procedures of lipoinjection, microsurgical flap transplantation, dermis grafting, distraction osteogenesis, orthognathic surgery and so on for both skeleton and soft tissue reconstruction., Results: Among them, zygomatic augmentation and lipoinjection were performed in 24 cases, anterolateral thigh adipofascial flap in 10 cases and latissimus dorsi flap in one case, orthognathic surgery in 17 cases, including Le Fort I osetoectomy in 3 cases, genioplasty in 4 cases, mandibular distraction osteogenesis combined with secondary Le Fort I osteotomy in 3 cases, genioplasty combined with mandibular augmentation with Medpor implant in 7 cases. The patients were followed up for 6 months to 5 years. Through skelton and soft tissue reconstruction, the oblique occlusion plane and malocclusion were corrected with great improvement in face asymmetry., Conclusions: For severe progreassive hemifacial atrophy, comprehensive procedures should be adopted for both skelton and soft tissue reconstruction to achieve good results.