Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy: Current Evidence and Future Directions

Abstract

rogressive hemifacial atrophy, or Parry-Romberg syndrome, is a rare disorder characterized by gradual, unilateral atrophy of soft tissue in the face within regions innervated by branches of the trigeminal nerve. 1 One widely used classification system, attributed to Iñigo et al., 2 denotes the disease as mild if atrophy is limited to one trigeminal nerve branch, or moderate if it involves two branches. Severe cases are either those involving all three trigeminal nerve branches, or if there exists any bony involvement. 2,3 Degeneration may persist over the course of 2 to 20 years, until spontaneous quiescence, with an earlier age of onset associated with more severe bony involvement and poorer outcomes, especially in pediatric patients. [4][5][6][7] Although treatment with agents such as steroids, methotrexate, antimalarials, and retinoids may be initiated early on during the disease process in an attempt to curb progression, 8 softtissue reconstruction is often necessary for restoration of form and function. 4,9 Although there exists a

Pediatric Microsurgery and Free-Tissue Transfer

“…22 23 24 Cross-facial nerve grafting may also be implemented prior to free gracilis muscle transfer in the setting of trauma or oncologic resection when an intact unilateral facial nerve remains. 25…”

“…[22][23][24] Cross-facial nerve grafting may also be implemented prior to free gracilis muscle transfer in the setting of trauma or oncologic resection when an intact unilateral facial nerve remains. 25 Parry-Romberg syndrome involves progressive, unilateral atrophy of the hard and soft tissues of the face. As Parry-Romberg only affects one side, it can create significant asymmetry and disfiguration.…”

Discussion: Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy: Current Evidence and Future Directions

“…In this article, Abi-Rafeh et al skillfully assembled the available knowledge on soft-tissue augmentation of patients with progressive hemifacial atrophy with the goal of defining a useful treatment algorithm, while also highlighting the deficiencies within the literature that prevent consensus on disease severity and treatment modalities. 1…”

“…In this article, Abi-Rafeh et al skillfully assembled the available knowledge on soft-tissue augmentation of patients with progressive hemifacial atrophy with the goal of defining a useful treatment algorithm, while also highlighting the deficiencies within the literature that prevent consensus on disease severity and treatment modalities. 1 In their quest, the authors encountered three obstacles. First, descriptions of progressive hemifacial atrophy disease severity varied widely and used arbitrary criteria.…”

Discussion: Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy: Current Evidence and Future Directions

“…W e commend the authors for their thorough review of soft-tissue management in Parry-Romberg progressive hemifacial atrophy. 1 Here, we offer one approach to reconstruction of progressive hemifacial atrophy patients based on the senior author's (J.W.S.) career experience.…”