Simultaneous Orthognathic Surgery and Costal Bone Grafting in Hemifacial Microsomia: A Rare Case Report and Literature Review.
Chi Hyun Lee, Hyun Seung Lee, Youn-Kyung Choi et al.
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Case in brief
A 20-year-old woman with type IIA hemifacial microsomia developed progressive mandibular resorption after previous two-jaw surgery, leaving a “floating” ramus-condyle segment and recurrent facial asymmetry. Revision combined a sagittal split ramus osteotomy on the unaffected side with long-plate fixation and costal bone grafting on the affected side. Split costal-bone fragments were placed between mandibular segments, with the remaining graft used as a lateral onlay. Follow-up showed preserved mandibular height and acceptable occlusion; subsequent fat grafting refined the soft-tissue contour.
What made this case unusual
The revision addressed progressive resorption and a floating ramus-condyle segment by combining orthognathic surgery with costal grafts used both between mandibular segments and as a lateral onlay.
Diagnostic / clinical pearl
In complex revision of hemifacial microsomia with mandibular resorption, assess skeletal stability and soft-tissue contour as separate but related goals; this case used combined osteotomy, costal grafting, and later fat grafting.