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      Síndrome de Goldenhar: protocolo de manejo quirúrgico en un centro de referencia Translated title: Goldenhar syndrome: surgical management protocol in a reference center

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          Abstract

          Resumen Objetivo: Presentar nuestra experiencia en el diagnóstico y el tratamiento de 42 pacientes con síndrome de Goldenhar. Método: Se realizó un estudio descriptivo, observacional y retrospectivo usando el registro médico y fotográfico de todos los pacientes diagnosticados con síndrome de Goldenhar tratados por la unidad de cirugía craneofacial del departamento de cirugía plástica y reconstructiva del hospital Dr. Manuel Gea González entre 2010 y 2018. Resultados: Se obtuvieron 42 pacientes, el 54% varones, con predominio de menores de 10 años (57%), de los cuales todos se sometieron al menos a un procedimiento. Los procedimientos quirúrgicos se dividieron en: 14 auriculares (20%), 17 mandibulares (24%), 2 Lefort (4%), 10 volumen (14%), 9 macrostoma (13%) y 16 otros (21%). En total se realizaron 71 procedimientos. Conclusión: El síndrome de Goldenhar es una enfermedad poco frecuente que afecta diversas estructuras y se presenta predominantemente en varones. Es necesario un diagnóstico precoz y un manejo individualizado llevado a cabo por un equipo multidisciplinario encabezado por cirujanos plásticos.

          Translated abstract

          Abstract Objective: To present our experience treating 42 patients with Goldenhar syndrome. Method: A descriptive, observational, retrospective study was carried out using the medical and photographic record of all patients diagnosed with Goldenhar syndrome treated by the craniofacial surgery unit of the plastic and reconstructive surgery department of the Dr. Manuel Gea González hospital between 2010 and 2018. Results: A total of 42 patients were obtained,54% male of which all underwent at least one procedure. The majority of patients were of the first decade of age (57%). Surgical procedures could be divided mainly into 14 auricular (20%), 17 mandibular (24%), 2 Lefort (4%), 10 volume (14%), 9 macrostoma (13%) and 16 other (21%). A total of 71 procedures were performed. Conclusion: Goldenhar syndrome is a rare entity that affects various structures, which is why an early diagnosis and multidisciplinary management headed by a team of plastic surgeons is necessary.

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          Most cited references20

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          Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update.

          Oculo-auriculo-vertebral spectrum (OAVS, OMIM 164 210) is a developmental disorder primarily involving structures derived from the first and second pharyngeal arches during embryogenesis. The phenotype is clinically heterogeneous and is typically characterised by abnormal development of the ear, mandible anomalies and defects of the vertebral column. OAVS may occur as a multiple congenital abnormality, and associated findings include anomalies of the eye, brain, heart, kidneys and other organs and systems. Both genetic and environmental factors are thought to contribute to this craniofacial condition, however, the mechanisms are still poorly understood. Here, we present a review of the literature on OAVS, discussing what is known about the aetiology, candidate loci, possible mechanisms and the range of clinical features that characterise this condition. We also comment on some important aspects of recurrence risk counselling to aid clinical management.
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            TOTAL RECONSTRUCTION OF THE EXTERNAL EAR

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              Surgical Correction of Hemifacial Microsomia in the Growing Child

              This is a follow-up study of 20 children who had surgical correction of hemifacial microsomia in an effort to improve facial growth and minimize secondary distortion. In group 1 (skeletal types I and IIA), 10 children underwent elongation and lengthening of the mandible. In group 2 (skeletal types IIB and III), 10 children had total construction of a new temporomandibular joint and mandibular ramus with rib grafts and costochondral junction. In both groups, an open bite was created on the affected side to provide space for tooth eruption and downward growth of the middle face. The mean follow-up was 50.9 months (18 to 117 months) in group 1 and 45 months (18 to 50 months) in group 2. Analysis of our early results showed that all patients have had downward growth of the midface on the affected side. All five patients in group 1, followed to complete closure of the surgically created open bite, have maintained a level occlusal plane. In group 2, the one patient followed to completion of facial growth continues to have a level occlusal plane and facial symmetry. Appropriately timed mandibular construction and/or elongation in children with hemifacial microsomia is safe and effective. There is a decrease in secondary deformity on the affected side, and the eventual overall facial growth is optimized. Some group 2 children will need secondary elongation and augmentation of the mandible. Nevertheless, this study demonstrates that early mandibular correction may obviate the need for maxillary and orbital procedures in adulthood.
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                Author and article information

                Journal
                cicr
                Cirugía y cirujanos
                Cir. cir.
                Academia Mexicana de Cirugía A.C. (Ciudad de México, Ciudad de México, Mexico )
                0009-7411
                2444-054X
                October 2019
                : 87
                : 5
                : 516-527
                Affiliations
                [1] Ciudad de México orgnameHospital "Dr. Manuel Gea González" orgdiv1Clínica de Cirugía Craneofacial orgdiv2Departamento de Cirugía Plástica y Reconstructiva México
                Article
                S2444-054X2019000500516 S2444-054X(19)08700500516
                10.24875/ciru.19000654
                92d29de3-1091-4de3-96ab-80c698931026

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 10 August 2018
                : 06 April 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 12
                Product

                SciELO Mexico

                Categories
                Artículos originales

                Cirugía plástica,Microsomía hemifacial,Síndrome de Goldenhar,Plastic surgery,Hemifacial microsomia,Goldenhar syndrome

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