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Hemifacial Microsomia

Causes of Facial Paralysis Hemifacial Microsomia

A condition called “Hemifacial Microsomia” is one in which part of the face did not develop normally. Development of the ear and the jaw are compromised but can be surgically improved. After clefts this syndrome runs in second for surgical aid for the patient.

Causes of Facial Paralysis Hemifacial Microsomia There are no studies that link “Hemifacial Microsomia” to the actions or activities of mother’s during pregnancy. Why it happens still baffles researchers. It could be a lack of blood supply to the fetus’s brachial arches in the first eight weeks of pregnancy. Adults wanting more children can expect a mere 1% chance of transferring Hemifacial problems to other children.

The winning idea behind surgery for children is the fact that the bone and soft tissue can be corrected. The age for these surgeries depends upon the surgeon and the general condition of the child. Common surgeries include:

Lowering the upper jaw to match the opposite side and lengthening the lower jaw. Sometimes a bone graft is used to lengthen the jaw and sometimes a distraction device is used. Ear reconstruction at about 5-6 years of age, involves 3 to 4 surgeries. Occasionally, it may be necessary to add bone to build up the cheekbone. Some children benefit from the addition of soft tissues to further balance the face.

Your child may have skin tags in front of the ear or on different parts of the face. Hearing problems depend on the structures that are involved. Some children have some weakness in movement on the affected side of the face.

At the Facial Paralysis Institute in Beverly Hills, Dr. Azizzadeh’s mission is to provide cutting-edge care to those who suffer from Hemifacial Microsomia. He aims to answer patients’ questions in a thoughtful and thorough manner to give them confidence about their treatment options. Here are answers to frequently asked questions about Hemifacial Microsomia.

Q: What is Hemifacial Microsomia?

A: Hemifacial Microsomia may occur on one or both sides of the face. It is present at birth and affects the lower half of the face, including the ears and mouth. These features do not develop properly to match the upper portion of the face and appear asymmetrical and uneven. Functional issues, such as breathing problems, may result from Hemifacial Microsomia deformities.

Q: What Causes Hemifacial Microsomia?

A: The condition develops in the fetal stage of pregnancy, usually between 4 and 8 weeks of gestation. However, Hemifacial Microsomia has no definitive causes. Vascular blockages or lack of blood supply to the face may contribute to the abnormal development of the lower region of the face.

Q: What Are the Best Treatment Options for Hemifacial Microsomia?

A: Dr. Azizzadeh assesses the best treatment plans for each individual patient. In cases of Hemifacial Microsomia, surgical procedures treat the jaw and ear areas. When children have surgery, the bone and soft tissue can be corrected to restructure the face in a more symmetrical way. Lengthening the jaw with a bone graft and ear reconstruction are a couple of common treatment options.

If you are suffering from facial paralysis or any other related condition, schedule a consultation with Beverly Hills facial paralysis expert Dr. Azizzadeh by calling 888.470.6432 today!












The parotid gland is a key pathway for the facial nerve and can have a significant role in facial nerve disorders.

What is the parotid gland?

figure1 salivary glands The Parotid Gland is an important salivary gland in the body.  This gland pumps saliva through the Stensen’s duct, into the mouth. This helps keep the mouth wet and helps with swallowing. Infections, trauma and tumors can potentially cause facial nerve problems. The longer it takes to correct a problem, the more surgery will be needed.

What causes the problems?

The most common causes of facial nerve disorders as a result of the parotid gland is tumors (pleomorphic adenoma), malignancy (adenoid cystic carcinoma, adenocarcinoma), trauma, and infectious process.  Even though the mumps have all been eliminated with routine vaccinations, this viral infection will give you an idea of how serious an infection of the Parotid gland can be.

Parotid tumors are typically benign and can be treated with surgery.  The most common parotid tumor is pleomorphic adenoma which usually presents with a pain-less lump at the jaw line in front of the ear.  Other tumors are typically more concerning and can be malignant such as adenoid cystic carcinoma, adenocarcinoma, and squamous cell carcinoma.

figure2 salivary glands Staphylococcus (Staph infections) aureus is the most common reason the Parotid gland becomes infected and usually if can be contained with antibiotics and anti-inflammatories. Bacteria that create tuberculosis are another factor that can cause Parotid infections. Another bacteria, which causes “Acute suppurative parotitis” is also a painful and similar infection. These can usually be treated by drugs.

Diabetes, bulimia and alcoholism may cause enlarged parotid glands but usually these are not painful and there is a small group of AIDS victims that have experienced parotitis.

figure3 salivary glands However, any blockage to the parotid duct such as a tumor, mucous plug, salivary stone is usually the cause of painful and deadly parotiditis. Calcium is what forms salivary stones. Usually they can be detected by X-ray about 80% of the time.

Chronic inflammation of the parotid gland may be caused by Sjogren’s syndrome. This is caused by an autoimmune disease and can be a serious problem. There is no known cause for Sjogren’s syndrome at this time. Dryness in the eyes, nose, skin and mouth in the facial area along with swelling is an indication of Sjogren’s syndrome.

facial nerve monitor

Where is it?

figure4 salivary glands The parotid gland sits under the skin, and wraps around the back of the jaw at the mandibular ramus. The gland sits in an area which is anterior to the ear. This gland is palpated bilaterally and there is one on each side of the head behind the ear. The facial nerve, although it does not control the gland, it runs through it.


incisions before and after


Surgery remains the gold-standard for treating parotid tumors.   Old methods of surgery include taking the gland out completely leave scars around the face and usually a dent in the area on the face, making it a more obvious problem.

salivary At the Facial Paralysis Institute, Dr. Azizzadeh and Dr. Larian use a multi-specialty approach to address parotid tumors.  Dr. Larian, is a renowned head and neck surgeon and the director of the Cedars-Sinai Head and Neck Cancer Center.  He uses cutting-edge techniques to safely remove the tumor with the highest rate of facial nerve preservation.  Dr. Azizzadeh, a facial plastic and reconstructive surgeon, helps to plan the surgical incision and reconstruction of the region so that a scar-free and dent-free results can be obtained.  Furthermore, given Dr. Azizzadeh's facial nerve expertise - the rate of facial nerve preservation and outcome is safely guarded.

Please call us anytime for a free consultation on how we may be able to treat your condition. The Facial Paralysis Institute is one of the most advanced centers of its kind in the world dealing with such problems.

If you are actively considering parotidectomy, schedule a consultation with Beverly Hills facial paralysis expert Dr. Azizzadeh by calling 888.470.6432 today!

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Dr. Azizzadeh is a co-director of the 2014 Multi-Specialty Plastic Surgery Symposium at Cedars-Sinai. 

Previous Symposiums:

Dr. Azizzadeh Selected as Course Director for 2013 Multi-Specialty Plastic Surgery Symposium


Dr Azizzadeh on The Oprah Winfrey Show with Mary Jo Buttafuoco

Mary Jo Buttafuoco had previously appeared on the Oprah Winfrey Show explaining that she continues to suffer from facial paralysis and ear damage from the shooting. After viewing the show Dr. Azizzadeh, a reconstructive surgeon, said to himself "This is someone I could definitely help. I decided that I was going to try to get a team together to make her life better." Read the full story on Dr. Azizzadeh and Mary Jo Buttafuoco here

Author Buttafuco looks at life after the headlines

Henderson resident chronicles her struggles with pain, notoriety and moving toward health

Mary Jo Buttafuoco became a household name when she was shot in the face by Amy Fisher, the teen-aged mistress ofher husband, JoeyButtafuoco, in 1992 Read more...

Dr. Azizzadeh was featured in People magazines Heroes Amongst Us section after performing a life-altering surgery on a child named Beloved from Zimbabwe who was deformed due to a land-mine accident

Read the full story here


Request your consultation with Dr. Azizzadeh today.
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Director, The Facial Paralysis Institute - Associate Clinical Professor - Facial Plastic & Reconstructive Surgery David Geffen School of Medicine at UCLA

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Dr. Azizzadeh’s facial nerve textbook is the preeminent textbook for doctors on the subject.