The Role of Orthodontists in the Continuum of Craniofacial Microsomia Care: Survey of Craniofacial Teams

Objectives: Craniofacial microsomia is a developmental defect that presents as an asymmetric development of craniofacial structures derived from first and second branchial arches. There is a wide variety of clinical presentations and severities to the condition. There is great variation in treatment protocols and timing among clinicians, particularly in the preference of surgical intervention before or after skeletal maturity. This study aims to identify craniofacial team related factors that are associated with the treatment protocols that they use and identify commonalities in various treatment protocols and establish a standardized treatment approach that can be used to treat patients with CFM. From the treatment protocols identified, we aim to qualitatively delineate the role of orthodontist in the continuum of craniofacial microsomia care and the various orthodontic and surgical interventions and their timing followed by the craniofacial teams across the United States. Methods: A 15-item questionnaire was distributed electronically to 121 craniofacial teams across the United States via Qualtrics Survey Software. The survey included 3 major blocks: Treatment Characteristics, Diagnosis, and Treatment of CFM. The questions explored craniofacial center characteristics, case load, diagnostic tools and systems, as well as preferences in surgical and orthodontic treatment methods. 22 respondents completed the full survey, thus resulting in an 18% response rate. Descriptive statistics were obtained to summarize the data Chi Square tests and Fisher’s Exact test were used to find any associations between predictor and outcome variables. All statistical tests were two-sided and statistically significant at a p-value of <0.05. Results: A statistically significant association was found between status of academic accreditation and number of active orthodontic cases, where non-academically accredited centers had fewer active orthodontic cases. No other statistically significant associations were obtained. Conclusions: Most respondents reported performing mandibular surgery after the pubertal growth spurt or at skeletal maturity. However, several participants reported an exception where early surgery may be considered during growth to control or improve facial asymmetry if the patient is experiencing significant psychosocial challenges compromising their quality of life. This sheds valuable light on the potential indications of early versus late surgical intervention. Most respondents reported using traditional orthodontic brackets with functional appliances and mini-implants as adjunctive treatment modalities to achieve orthopedic and orthodontic treatment objectives. The results of this study provide a framework for future studies to define a clear standard of care for craniofacial microsomia cases.