Lazarus, Lelika.Madaree, Anil.Atiba, Peterson Makinde.2025-11-192025-11-192024https://hdl.handle.net/10413/24121Doctoral Degree. Universal of KwaZulu-Natal, Durban.Introduction: This study uses clinical and morphometric analyses to investigate facial asymmetry (FA) in hemifacial microsomia (HFM) patients, specifically focusing on mandibular hypoplasia. It also assesses the effectiveness of autologous fat graft (AFG) camouflage for FA in a South African population. Materials and Methods: This retrospective study analysed 25 HFM patients, confirming diagnoses through plain radiographs or computed tomography. Patient charts provided data on age, sex, laterality, deformity severity, and associated anomalies. Malformations were categorised using the OMENS classification, and patients were grouped by Pruzansky-Kaban grading (mild/severe) and age (1-5, 6- 12, 13-19 years). Linear and angular measurements of the mandibular ramus and body from preoperative CT scans were used to compare severity, age groups, and affected-to-contralateral side ratios. Additionally, ten Pruzansky grades I and II patients (4-16 years) with unilateral FA received AFG, divided into AFG-treated (mean age: 5.8 ±3.89 years) and mandibular distraction osteogenesis combined with AFG (MDO+AFG)-treated (mean age: 8.8 ±4.32 years) groups, each with five patients. Results: Twenty-five HFM patients (M:F 1:1.78; 60% Black; 32% Indian; 4% White; and 4% Coloured; R:L 1.4:1) found 100% mandibular hypoplasia and soft tissue defects, with high rates of ear (84%), orbital (40%), and facial nerve (60%) involvement. Other craniofacial and extracraniofacial anomalies were 84% and 40%, respectively. Significant differences were found in mandibular linear and angular measurements and ramus-body index (RBI) between affected and contralateral sides, excluding mandibular body length (MBL). However, mean RBI differences between mild and severe deformities were insignificant, as was the affected-to-contralateral (A/C) ratio between severity groups and across age groups. In the AFG group, mandibular ramus height (MRH) and mandibular ramus width (MRW) significantly increased post-treatment, while chin point deviation (CPD) and occlusal plane angle (OPA) significantly decreased (p<0.05). The MBL significantly increased in the MDO+AFG group, but mandibular body height (MBH) did not. Growth increases were comparable between affected and unaffected sides in both groups. Conclusion: Notably, deformities in HFM vary significantly among the South African population. This study indicates that HFM is non-progressive, suggesting surgery should be delayed until skeletal maturity. MDO and AFG improve symmetry, with AFG effective for mild cases.enCC0 1.0 Universalhttp://creativecommons.org/publicdomain/zero/1.0/Facial asymmetry.Hemifacial microsomia.Cranial Neural Crest Cell.Autologous fat grafting.Distraction Osteogenesis.Thesis