fig15

Figure 15. Pruzansky-Kaban Type IIb, after joint reconstruction with costochondral grafting. The patient has orbital facial nerve paresis, a small and displaced left orbit, cervical vertebral fusions and scoliosis, macrostomia and commissurala symmetry, microtia, and hearing and speech problems (Goldenhar syndrome). Because of the vertebral column problems, her neck is in an oblique position, and her head is off-center in relation to her body. Her head is positioned somewhat less obliquely than her neck. Her bipupillary plane is not horizontal. There is no drooping of the brow on the affected side, despite the facial nerve paresis. It is difficult to know which reference plane to choose for positioning the occlusal plane and maxillary dental midline. (a) Frontal view, natural head position; (b) frontal view, with normal mouth opening