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Medical Cases

JULY 2016

Dr. Jyoti Jadhav

Star Imaging and Research Centre Medical case list

HISTORY

Case Courtesy:
Dr. Ashish Davalbhakta
  • 30 year adult male presented with right sided facial asymmetry

FINDING & CONCLUSION

  • Axial CT scan showing right sided lipomatous enlargement of the soft tissue of face including buccal region, lips, tongue and parotid gland
  • Enlargement of the right mandibular condyle, mandibular body, and zygoma seen on Coronal and Lateral view of VRT CT images
  • Enlargement of subcutaneous adipose tissue and muscles of mastication on right side. Facial asymmetry is predominantly due to soft tissue enlargement
  • True Hemifacial hypertrophy
  • Etiology is unknown
  • Sex: M > F
  • More commonly affecting right side of face
  • Hemifacial hypertrophy is a rare developmental anomaly characterized by asymmetric growth of more than one part of the face
  • Hemifacial hypertrophy divided into
  • (a) true and (b) partial hemifacial hypertrophy
  • True hemifacial hypertrophy: unilateral enlargement of all tissues, teeth, bones, and soft tissues,
  • In partial hemifacial hypertrophy not all structures are enlarged to the same degree or limited to one structure
  • Characterized by viscerocranial enlargement, bounded by frontal bone superiorly (sparing the eye), inferior border of the mandible inferiorly, midline medially, and ear including the pinna laterally
  • Isolated hemifacial hypertrophy should be a diagnosis of exclusion, because there are other more clinically burdensome conditions that can cause facial asymmetry. These conditions include the following: Proteus syndrome, BWS, NF1, and vascular malformations such as Klippel Trenaunay syndrome and lymphaticovenous malformations
  • Treatment is not indicated for HFH unless cosmetic considerations are involved
  • Orthognathic surgery and ostectomies are treatment of choice