Understanding Hemifacial Microsomia (HFM)
Hemifacial microsomia (HFM) is a condition that affects the form and shape of the bones and tissues of the face. Your child’s face may look uneven. This is because one side of the face is less developed. It most often affects the jaw, cheek bone, and ear. In some cases, both sides may be affected. It is a congenital problem. This means that a child is born with it.
How to say it
What causes hemifacial microsomia?
HFM often happens by chance. It can develop during pregnancy at around 4 weeks of a baby’s growth. It occurs because of problems with blood vessels that don’t let enough blood flow to the face.
It may also run in some families. HFM may be passed on (inherited) through a faulty gene in these ways:
Autosomal dominant. This means that only one parent passes the gene on to the child. Each child has a 1 in 2 chance of having the condition.
Autosomal recessive. This means that both parents must have the gene to pass it on. Each child has 1 in 4 chance of having HFM.
Multifactorial. This means that many factors are involved. The factors are often genetic and external, such as injury during pregnancy.
This condition may also occur in children who have other chromosome problems. Chromosomes are the structures in our cells that carry our genes. These types of problems often occur by chance.
Symptoms of HFM
Symptoms can occur a bit differently in each child. They may range from mild to severe. Areas of one side of the face may have less growth and be shaped differently, such as:
Outside and middle of the ear
Side of the skull
Bone around the eye
Thickness of the cheek
Upper and lower jaws
The condition may also affect some of the nerves in the face. This can cause weakness and problems with moving parts of the face. In some cases, other parts of the body may also be affected by HFM.
A geneticist may diagnose HFM. This is a doctor with extra training to diagnose and treat conditions passed down in families (genetic conditions). The doctor will look at your child’s health history. He or she will give your child a physical exam. Your child may also have tests such as:
X-rays of the head. X-rays use a small amount of radiation to show tissues and bones inside the body.
CT scan. A CT scan uses a series of X-rays to show detailed images of the body. Your child may need a CT scan of the head. This test will show his or her bones, muscles, and other tissues.
Treatment for HFM
If your child has severe facial changes, he or she may need several surgeries. In this case, your child will be checked by a craniofacial anomalies team. This is a group of doctors who diagnose and treat problems of the face.
This team may include:
A craniofacial surgeon who can do jaw surgery and ear reconstruction
An ophthalmologist to diagnose and treat eye and vision issues
An orthodontist to check and treat jaw growth and position
An ear, nose, and throat doctor (otolaryngologist) to check hearing loss
A speech therapist to help with speaking problems
Your child’s treatment may include:
Fixing your child’s lower jaw, using a bone graft taken from your child’s ribs
Using a device to change the shape of your child’s jaw
Surgeries to fix your child’s ear or cheeks
Removing or changing the position of your child’s teeth
Possible complications of HFM
If your child has mild facial changes, he or she may not be at risk for complications. Children with more severe changes may be more likely to have issues. These can include:
Trouble with self-image
Helping your child live with HFM
HFM support groups can help you and your child. Ask your child’s healthcare provider about support groups in your area.
When to call your child’s healthcare provider
Call the healthcare provider if your child has:
Trouble gaining weight
Other new problems
May 03, 2018
Baskin JZ, Flink. Cummings Otolaryngology Head and Neck Surgery. 2010, 5th ed., pp. 2646-7., McCarthy JG. Grabb and Smith's Plastic Surgery. 2007, 6th ed., pp. 248-55.
Shelat, Amit, MD,Turley, Raymond Kent, BSN, MSN, RN