Partial facial hemihypertrophy: A case report
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A 17-year-old female patient presented to our department with the complaint of facial asymmetry since birth which has been increasing with time. The birth of the patient was by normal delivery. On extraoral examination, there was gross asymmetry with prominent swelling on the left side of the face with following extensions: superiorly, a horizontal line joining the left infraorbital margin to the left upper lobe of the ear; inferiorly, a horizontal line along the lower border of mandible; medially, a vertical line extending from medial canthus of the left eye through the left corner of the lip to the lower border of the mandible; and laterally, a vertical line passing parallel along the posterior border of mandible.

Skin over the swelling appeared normal except for presence of light brown pigmentation over the skin in front of the left ear and also over anterior neck region. Ramal height was increased with respect to the left side leading to bowing of the left angle of the mandible and deviation of the chin to the right side. Bony outgrowth was evident with respect to the left infraorbital region and left malar prominence. The left ear appeared enlarged as compared to right side. On palpation, swelling was soft in consistency, nontender, nonflunctuant, and noncompressible in nature. No paresthesia was evident.

On intraoral examination, mouth opening was within normal limit. Occlusion was satisfactory with mild open bite with respect to the anterior teeth. Size of the maxillary and mandibular molars along with the alveolar ridges appeared enlarged with respect to the affected side. Canting of the occlusal plane was observed to be downward toward the left. Radiographic investigation included orthopantomogram and posteroanterior cephalogram, which revealed left condylar enlargement along with widening of the left inferior alveolar canal. Furthermore, macrodontia was seen with respect to the left maxillary and mandibular molars along with the enlarged roots with respect to the same teeth. Noncontrast computed tomography confirmed bony overgrowth with respect to the left infraorbital region, left ramal, and left zygoma area. Furthermore, disproportionate enlargement of soft tissues on the affected side was visible on computed tomogram suggestive of increased fatty tissue.

The history of the patient along with physical findings, X-ray examinations, and photograph leads to the final diagnosis of partial facial hemihypertrophy. Laser depigmentation was attempted twice for the skin lesion at the age of 15 years, but to no effect. Left condylectomy was done through the left preauricular approach along with shaving of excess bone with respect to the left zygoma and left infraorbital region through intraoral maxillary left vestibular approach. Furthermore, shaving of the bony overgrowth with respect to the left angle and left lower border of the mandible was done through intraoral crown's incision and vestibular approach under general anesthesia. Follow-up of 6 months shows much reduced facial deformity.