Abstract: The Kawamoto Classification Scheme for Parry Romberg Syndrome (Plastic Surgery 2013)

Saturday, October 12, 2013: 11:30 AM

Andrew Li, MD , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Anisa Yalom, MD , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

James Lee, BS , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Clifton Meals, MD , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Katrina Dipple, MD , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Heddie Sedano, DDS , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Henry Kawamoto, MD DDS , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

Reza Jarrahy, MD , Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA

PDF file

Purpose: Parry-Romberg syndrome (PRS) is a rare degenerative disease of the face marked by unilateral atrophy of the skin, soft tissues, muscles, and facial bones. Although multiple series of patients and their treatments have been described in the literature, there is little consensus regarding the optimal management of PRS (1). We describe our surgical experience with PRS and explore the optimal approach to surgical reconstruction and describe a new classification scheme with both prognostic and therapeutic implications.

Methods: The cases of 18 patients with Parry-Romberg Syndrome treated over a 27-year period at UCLA were examined. In total, 68 procedures were performed during the study period. Major procedures included autologous fat grafting, bone grafting, and corrective orthognathic surgery. Ancillary procedures such as de-fatting of soft tissue grafts, canthopexy, scar revision, and blepharoplasty were utilized as necessary to optimize aesthetic outcomes.

Based on this collective clinical experience, a new classification system was developed. Type A: atrophy of the skin and subcutaneous tissues, without evidence of bone involvement. Type B: atrophy of the skin and subcutaneous tissue with skeletal hypoplasia or other bony malformation but without clinically significant malocclusion. Type C: Atrophy of the skin and subcutaneous tissue with skeletal hypoplasia or other bony malformation causing severe malocclusion.

Results: Patients with Type A disease (n=7) averaged 1.8 procedures each and achieved excellent results with either serial fat grafting or free flap reconstruction. Patients with Type B disease (n=4) required an average of 7 procedures each and achieved moderate to excellent results by a combination of fat grafting, free flaps, and bone grafting. Patients with Type C disease (n=7) averaged 4.4 procedures and achieved moderate to excellent results with a combination of orthognathic surgery, bone grafting, and soft tissue transfer.

Conclusion: In this study we present a series of 18 cases of Parry-Romberg Syndrome. Based on this experience, we have developed a new classification scheme with both prognostic and therapeutic value. This will assist with patient counseling, categorization and communication between colleagues, and standardization of management plans to help improve overall patient care and maximize functional and aesthetic outcomes.

22501 The Kawamoto Classification Scheme for Parry Romberg Syndrome