Selective-ramus reconstruction with costochondral graft in hemifacial microsomia

Hemifacial microsomia (HFM) presents with complex hard and soft tissue deficiencies that challenge reconstruction, especially when mandibular segments are absent. An early childhood patient with right-sided hemi-mandibular hypoplasia (not consistent with the current Pruzansky-Kaban Classification but close to type III) and a rudimentary condyle underwent mandibular reconstruction using a costochondral graft extending from the body to the rudimentary condyle restoring the entire ramal portion. Postoperatively, the patient achieved improved facial symmetry, enhanced mandibular movements and better masticatory function. Patient follow-up was kept at 1st, 3rd, 6th and 12th months. The graft showed good integration, and preservation of the native condyle facilitated growth and functional restoration in comparison to distraction osteogenesis as an option for corrective surgery. Costochondral graft reconstruction provides a biologically favourable solution in growing HFM patients, though future corrective surgeries may be required to refine facial symmetry and occlusal balance as growth continues.