Introduction: The spectrum of craniofacial microsomia ranges from mild unilateral mandibular hypoplasia to gross facial asymmetry involving hypoplasia of the temporo-zygomatico-orbital complex, masticatory muscles and mandibular condyle/ramus unit together with cranial nerve palsies. Various interventions have been recommended by many Units to correct these facial deformities, particularly unilateral interim distraction osteogenesis.

Objective, patient and methods: It is the objective of this presentation to discuss the protocols of management in these patients with respect to the need for staged surgical intervention that will produce the best outcome for adult life. The distribution of patients with mandibular Type I, IIA, IIB and III deformities was recorded from our Unit database and the protocols for management identified.

Results: Early composite free tissue transfers were initially undertaken but resulted in unpredictable soft tissue bulk. Attempts to minimize asymmetry with distraction techniques were also abandoned as definitive skeletal correction was required in all patients in any case. Patients will be presented demonstrating the results using traditional orthognathic techniques following the reconstruction of the condyle/ramus unit where indicated in severe cases.

Conclusion: As yet, there is no consensus regarding the optimum protocol for managing craniofacial microsomia and while initially promising, it is our view that unilateral distraction does not confer any significant advantage over existing skeletal correction techniques.

Conflict of interest: None declared.