Orthodontic and surgical management of Goldenhar's syndrome, including joint replacement, orthognathic surgery, and polyetheretherketone implants, using virtual surgical planning

Abstract

Goldenhar syndrome is a rare syndrome with multiple facial characteristics. These include incomplete development of the ear, nose, soft palate, mandible, maxilla, zygoma, and ocular abnormalities as well. Treatment of these patients requires a multidisciplinary approach involving the orthodontist, craniofacial surgeon, and potentially other specialists. This paper presents a case of Goldenhar's, with detailed treatment objectives which required comprehensive orthodontic care, virtual surgical planning, orthognathic surgery, multipiece maxillary procedure including approximately 14 mm down graft on the affected, right side with an iliac crest bone graft, bilateral temporomandibular joint replacement with advancement of the mandible, polyetheretherketone facial implant for pogonion, on the lower border of the right side of the mandible and right malar area. The treatment outcome reflects a significant improvement in occlusal function, range of movement, and improved facial esthetics, although there is still a 1-2 mm cant of the occlusal plane.