Hemifacial Microsomia

Gillette Children’s Specialty Healthcare is a leading provider of craniofacial and plastic surgery for patients who have complex conditions, such as hemifacial microsomia. We provide expert evaluations and treatments in facilities designed specifically for children and families. Our team uses advanced surgical techniques and is committed to superb outcomes in both appearance and function.

 Why Choose Gillette?

  • Our fellowship-trained pediatric craniofacial and plastic surgeons understand the unique needs of people who have hemifacial microsomia—including how it affects appearance and function.
  • Our experts collaborate to provide comprehensive treatments that maximize results.
  • We pride ourselves on achieving the best possible outcomes in appearance and function.
  • Our state-of-the-art technology and facilities are designed specifically for your needs.
  • We believe that people who have disabilities deserve a lifetime of excellent health care — from birth through adulthood.


Hemifacial microsomia (HFM) occurs when the lower half of one side of the face is underdeveloped and does not grow normally. The condition is also called first and second brachial arch syndrome, oral-mandibular-auricular syndrome, lateral facial dysplasia, and otomandibular dysostosis. The condition varies in severity, but always includes the under-development of the ear and lower jaw.

Hemifacial Microsomia Types

HFM ranges from mild to severe and can involve different areas of the face. In more severe cases, the following areas of the face are underdeveloped:

  • External and middle ear
  • Side of the skull
  • Thickness of the cheek tissue
  • Upper and lower jaws
  • Teeth
  • Some of the nerves that control facial movement

In milder forms of HFM, only some of the structures of the face are affected, and they are affected to a lesser extent than in severe cases.

Hemifacial Microsomia Symptoms and Effects

Children who have HFM might have the following problems:


  • Small ear (microtia)
  • No ear canal (aural atresia)
  • Skin tags in front of the ear
  • Other ear abnormalities


  • Difficulty moving muscles of the face
  • Small cheekbone
  • Pinkish-white growth on the eye
  • Wide mouth (macrostomia)
  • Cleft lip and palate

Jaw and Teeth

  • Limited opening of the mouth
  • Short lower jaw
  • Crooked lower jaw
  • Bad bite (malocclusion)

Hemifacial Microsomia Incidence, Causes and Risk Factors

HFM is the second most common facial birth defect, after cleft lip and palate. Researchers aren’t sure what causes HFM. Most agree, however, that something occurs in the early stages of pregnancy, such as a diminished blood supply to areas of the fetus that affect facial development. Studies don’t link the condition to the mother's actions during pregnancy.

Parents of one child who has hemifacial microsomia have a less than a 1 percent chance of having additional children with hemifacial microsomia. Adults who have the condition have a 3 percent chance of passing it to their children.

Hemifacial Microsomia Tests and Treatments

Our specialists diagnose HFM after reviewing the patient’s medical history and performing a physical examination. Because the spectrum of severity for the condition is so wide, an experienced geneticist skilled in identifying craniofacial abnormalities typically makes the diagnosis.

Diagnostic tests to confirm the diagnosis of HFM might include:

  • X-rays of the head: X-rays produce images of internal tissues and bones of the head and face.
  • CT scan of the head: CT scans produce more detailed images of the head and face—including bones, muscles and fat—than X-rays do, making HFM easier to diagnose.

Most children who have HFM will need several surgeries to improve facial symmetry. Surgery can reconstruct bony and soft tissues, establish normal alignment of the upper and lower jaw, and create normal jaw function. The timing of each surgery varies depending on the severity of the problems. Common surgeries include:

  • Lowering of the upper jaw to match the opposite side
  • Lengthening of the lower jaw
  • Ear reconstruction at about 5 to 6 years of age
  • Addition of bone to build up the cheekbone
  • Addition of soft tissue to further balance the face

Hemifacial Microsomia Services

Specialties and services most often involved in the care and treatment of HFM include:

For more information about Gillette’s specialties and services, search Conditions and Care.

Why Gillette?

Because all children deserve a lifetime of amazing health care.

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