Hemifacial Microsomia
Children with microtia frequently have some degree of hemifacial microsomia (facial asymmetry). This asymmetry is variable and can be very subtle and difficult to see or it can be significant and quite noticeable.
There usually is some decreased fullness of the cheek on the affected side. The difference can be seen more clearly when viewing the child in a mirror. Less commonly, there is lower jaw asymmetry causes by decreased growth of the mandible (the lower jaw) on the affected side. The asymmetry can be seen as a slight shift of the chin toward the affected ear.
If the lower jaw is more involved, the occlusal (grinding or biting surface of a tooth) plane between the upper and lower jaws will tilt upward on the affected side rather than be the normal flat plane.
There also can be an asymmetry of the mouth which is related to a weakness of one of the branches of the facial nerve. In this case, the affected lower lip does not move down as much as the normal side, most noticeably when the child laughs or cries.
Children that show some degree of facial asymmetry, even without microtia, may be diagnosed as having hemifacial microsomia, first and second branchial arch syndrome, facial auricular vertebral syndrome, and Goldenhar syndrome.
Children whose faces look symmetric at birth usually don't develop noticeable facial deformity with growth. Children with very noticeable facial asymmetry at birth, may improve somewhat with age, and may require additional treatment to improve facial balance. The symmetry is often achieved by a "fat injection," transferring a small amount of fat from the child's abdomen, using liposuction, to the small side of the face.
