Introduction: Hemifacial microsomia (HFM) is among the most variable maxillofacial syndromes showing unpredictable growth patterns. Therefore the severity of deformity greatly differs from total absence of ramus/condylar unit to negligible morphologic changes of the affected site.

Aim: Prospective, longitudinal, clinical long-term follow-up study of three children affected by hemifacial microsomia were treated by distraction osteogenesis combined with inverted L osteotomy or costochondral grafts for ramus lengthening.

Materials and methods: Three male children two of whom having Type IIa, and one of whom having type III (Kaban classification) HFM patients were operated. Unilateral ramus distraction was applied to all cases. Additionally, inverted L mandibular osteotomy of underdeveloped ramus and sagittal split osteotomy of non affected site were performed in Type IIa cases. The patient with Type III deformity had autogenous costochondral graft for condylar/ramus reconstruction. Vertical and horizontal changes of the affected ramus were evaluated clinically, radiographically in a long term follow-up.

Results: Inverted L osteotomies with autogenous block grafts provide larger antero-inferior advancement of deficient ramus. Maxillary growth was also promoted by increasing the size of underdeveloped mandible vertically and horizontally.

Conclusion: These treatment modalities represent efficacious additional options for ramus lengthening in HFM patients.

Conflict of interest: None declared.