Our findings suggest that normal or physiologic closure of the metopic suture occurs much earlier than what has been previously described. This study establishes that metopic fusion may normally occur as early as 3 months of age, and that complete fusion occurred by 9 months of age in all patients in our series. Therefore, 3-D CT scans showing complete closure of the metopic suture at an early age (3 to 9 months) cannot be considered as evidence of metopic synostosis, and thus, should not be the decisive factor for early surgical intervention.

The use of a Medpor framework after prolonged tissue expansion provides a well-defined, well-projected ear with robust soft tissue coverage. The expanded skin envelope with this method provides sufficient retroauricular non-hair-bearing skin tissues for draping the framework without the need for temporoparietal fascial flap or skin grafting. This alternative surgical method reduces surgical time and morbidity, and facilitates an aesthetic, natural-appearing reconstruction of the auricle.

No abstract

Facial asymmetry in hemifacial microsomia can be corrected by an effective procedure of gradual distraction of the mandible. In younger children with deciduous dentition, changes in dental occlusion secondary from mandibular distraction can be easily corrected with orthodontic treatment. In older patients, mandibular elongation through distraction osteogenesis can produce good aesthetics but can create a severe alteration in occlusion requiring complex orthodontic treatment during an extended period. A Le Fort I osteotomy was performed simultaneously with mandibular corticotomy to avoid this problem. We present an 11-year-old patient with grade II hemifacial microsomia with facial asymmetry that was corrected with a combined simultaneous distraction of the maxilla and mandible using a single mandibular distraction device and an interdental splint. Excellent facial symmetry was achieved while maintaining preexisting dental occlusion.