First And Second Branchial Arch Syndrome: A Comprehensive Treatment Approach

First and second branchial arch syndrome is a rare congenital craniofacial disorder . This report details a comprehensive treatment protocol for this complex condition, highlighting the importance of multidisciplinary collaboration. A 10-year-old child presented with facial asymmetry. Clinical examination revealed shortening of the left mandible, underdeveloped external ear with accessory auricles, and facial asymmetry with left side smaller than the right. The menton was displaced to the right by 10 mm. Intraoral examination revealed a 5mm deviation of the occlusal plane. Imaging studies demonstrated left facial hypoplasia and abnormal mandibular morphology. Clinical and imaging evaluations confirmed first and second branchial arch syndrome. Treatment was divided into two phases: Phase 1 involved distraction osteogenesis(DO) to lengthen the left mandible. Phase 2 included orthognathic-orthodontic combined treatment with Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, followed by contouring surgery. The treatment lasted 15 years. Treatment of this syndrome requires a multidisciplinary synthetic and sequential therapy tailored to the patient's age, deformity severity, and growth stage. DO effectively increased mandibular length, while orthognathic surgery optimized facial morphology. This case underscores the need for collaborative care and highlights the effectiveness of a staged treatment protocol, though a standardized treatment protocol remains elusive. This case demonstrates the successful management of first and second branchial arch syndrome through a comprehensive, multidisciplinary approach. The staged treatment protocol significantly provides a valuable reference for clinicians dealing with similar complex craniofacial deformities.