Virtual planning bone distraction as a golden standard in the treatment of hemifacial microsomia due to Goldenhar syndrome

First described by Von Arlt in 1845, the Goldenhar syndrome was not recognized as an entity until 1952, when the Belgian-American ophthalmologist described the syndrome that bears his name [1]. It has a rare incidence and multifactorial etiology with many prenatal risk factors involved, such as vasoactive drugs, gestational diabetes, twin pregnancies, second trimester bleeding, and artificial reproductive techniques [2]. The syndrome is characterized by peribulbar and/or labial dermoids, atrial appendages and atrial fistulas with a blind bottom located in the pretragus region, microtia and vertebral anomalies [3]. Due to the occurrence of several cases of hemifacial microsomia, this change was considered a distinctive feature of the entity in 1976 [4]. That means the maxillofacial surgeon is under obligation to update and recycle to work with these patients. The syndrome should be diagnosed as soon as possible so the treatment is early and patients do not suffer from physical, psychological, and social developmental delays. Variouc techniques are used in the treatment of hemifacial microsomia, such as bone grafts, customized prosthesis, and bone distraction [5]. The first report on the use of bone distraction in the treatment of hemifacial microsomia in patients with Goldenhar Syndrome dates back to 1996 and is now, after 25 years, it is one of the treatments with considerable acceptance in the literature, although there are not many publications on the subject. Hemifacial microsomia is the second-highest incidence of congenital craniofacial malformations after cleft lip and palate [5].