--- title: "Goldenhar Syndrome and Orthodontics UK Guide" url: https://virtualconsultant.online/guides/goldenhar-syndrome-orthodontics-uk description: "Goldenhar syndrome and orthodontics in the UK: mandibular asymmetry, macrostomia, staged jaw surgery, and craniofacial team coordination." updated: 2026-09-07T00:00:00Z publisher: Virtual Consultant Online --- Goldenhar Syndrome Craniofacial Jaw Asymmetry Rare Conditions # Goldenhar Syndrome and Orthodontics UK Goldenhar syndrome — also known as oculo-auriculo-vertebral spectrum (OAVS) or craniofacial microsomia at its more involved end — is a rare condition present from birth in which structures on one side of the face, including the jaw, ear, and sometimes the eye, do not develop fully. For families of a child with Goldenhar syndrome, orthodontic care is one part of a much longer craniofacial treatment programme, and understanding how the jaw asymmetry develops and when to expect orthodontic and surgical intervention can help set realistic expectations. This guide is for information only and does not replace advice from your child's craniofacial, orthodontic, or genetics team. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Compare Costs](https://virtualconsultant.online/costs) ## What is Goldenhar syndrome? Goldenhar syndrome is a rare congenital condition, present from birth, in which structures derived from the first and second branchial arches fail to develop fully — usually on one side of the face, though both sides can be affected to different degrees. It sits within a wider group of conditions known as oculo-auriculo-vertebral spectrum (OAVS), which also includes hemifacial microsomia; Goldenhar syndrome is generally used to describe presentations that also involve the eye (typically an epibulbar dermoid, a benign growth on the surface of the eye) and the spine (vertebral anomalies), in addition to the ear and jaw differences common across the spectrum. The exact cause is not fully understood, and most cases occur without a clear family history, though the underlying mechanism is thought to relate to disrupted blood supply or development of tissue in the affected region during early pregnancy. ## How Goldenhar syndrome affects the jaw and bite The jaw findings in Goldenhar syndrome centre on underdevelopment of the mandible on the affected side, most often involving the ramus (the vertical part of the jawbone) and the condyle — the rounded end that forms the jaw joint. Where the condyle is absent, rudimentary, or structurally abnormal, the temporomandibular joint on that side does not function normally, which can limit mouth opening and alters how the lower jaw grows relative to the upper jaw over childhood. As the unaffected side continues to grow normally, the difference between the two sides tends to become more pronounced with age rather than staying static, producing a chin and lower jaw that deviate towards the affected side, a tilted (canted) bite plane, and dental crowding or displacement, particularly on the affected side. ## Macrostomia and its effect on orthodontic assessment Macrostomia — a lateral facial cleft that widens the corner of the mouth on the affected side, sometimes described as an unusually wide mouth on one side — is a recognised feature in some children with Goldenhar syndrome, alongside soft tissue tags near the ear and cheek. Where present, macrostomia is usually corrected surgically by a craniofacial or plastic surgery team in early childhood, since it affects both appearance and oral competence (the ability to close the lips fully). For orthodontic assessment, macrostomia repair and the resulting scar tissue around the corner of the mouth are relevant background: they can affect lip and cheek muscle tone and tension on the affected side, which in turn can influence tooth position and the pattern of dental crowding as the permanent teeth erupt. ## Ear involvement, hearing, and coordinating dental appointments Ear differences — ranging from small skin tags to microtia (an underdeveloped outer ear) and aural atresia (absence or narrowing of the ear canal) — are common in Goldenhar syndrome and often accompany conductive hearing loss on the affected side. While ear reconstruction and audiology care sit with ENT and plastic surgery teams rather than the dental team, hearing loss is worth flagging at dental and orthodontic appointments so that instructions are given clearly, ideally facing the child and confirming understanding, particularly before any procedure involving unfamiliar sounds such as impression-taking or intraoral scanning. ## Distraction osteogenesis and staged jaw correction For children with significant mandibular underdevelopment, distraction osteogenesis — a technique in which the jawbone is surgically divided and then gradually lengthened using a small device that separates the bone by about a millimetre a day, allowing new bone to fill the gap — may be used in early to mid-childhood to reduce asymmetry and, in cases with airway involvement, to improve breathing. This is typically followed by a period of orthodontic monitoring and, in adolescence or early adulthood once facial growth is complete, definitive orthognathic (jaw) surgery to correct any residual asymmetry and establish a stable, functional bite. Our separate guide to hemifacial microsomia orthodontic management covers the staging of distraction osteogenesis and orthognathic surgery in more detail, since the surgical pathway is shared across the OAV spectrum. ## Vertebral anomalies and positioning for dental treatment Vertebral anomalies — commonly affecting the cervical (neck) spine, such as fused or malformed vertebrae — occur in a proportion of children with Goldenhar syndrome and are usually identified through spinal imaging as part of the wider diagnostic work-up. Where present, these can affect neck mobility and the range of head positioning that is comfortable or safe during dental treatment, particularly for procedures requiring the head to be tilted back. The dental or orthodontic team should be made aware of any diagnosed vertebral involvement so that the dental chair position and any general anaesthetic airway management, if ever required, can be planned accordingly by the anaesthetic team. ## What NHS orthodontic and craniofacial care looks like for Goldenhar syndrome In the UK, children with Goldenhar syndrome are typically cared for by one of the NHS specialist craniofacial units — including Great Ormond Street Hospital, Alder Hey Children's NHS Foundation Trust, Birmingham Children's Hospital, and the Oxford Craniofacial Unit — which coordinate input from maxillofacial surgery, orthodontics, ENT, ophthalmology, speech and language therapy, and clinical psychology across childhood and into early adulthood. Orthodontic assessment usually begins in the mixed dentition years to establish a baseline and monitor how the asymmetry is developing, with active treatment timed around any planned distraction osteogenesis or definitive jaw surgery rather than following a fixed generic schedule. Because the condition spans multiple specialties, sharing imaging, surgical reports, and audiology results with the orthodontic team at each stage helps keep the overall treatment plan properly coordinated. ## Supporting a child with Goldenhar syndrome through orthodontic treatment Children with visible facial differences, including those from Goldenhar syndrome, can experience self-consciousness or social anxiety related to their appearance, and orthodontic treatment — particularly any discussion of jaw surgery — can bring this to the surface at different ages. UK charities such as Goldenhar UK connect families for peer support and practical guidance, and craniofacial units typically include clinical psychology support as a routine part of the care pathway rather than something families need to specifically request. Involving the child in age-appropriate discussion about their treatment plan, and giving realistic timeframes for what orthodontics can and cannot achieve before any planned jaw surgery, helps manage expectations through what is often a many-year treatment journey. ## Useful related pages [Patient FAQs Hub](https://virtualconsultant.online/faq) [Hemifacial Microsomia and Orthodontics UK](https://virtualconsultant.online/guides/hemifacial-microsomia-orthodontics-uk) [Facial Asymmetry and Orthodontics UK](https://virtualconsultant.online/guides/facial-asymmetry-orthodontics-uk) [Cleft Palate and Orthodontics UK](https://virtualconsultant.online/guides/cleft-palate-orthodontics-uk) [Jaw Surgery and Orthodontics UK](https://virtualconsultant.online/guides/jaw-surgery-orthodontics-uk) [Bone Grafting Before Orthodontics UK](https://virtualconsultant.online/guides/bone-grafting-before-orthodontics-uk) [Get a Virtual Consultation](https://virtualconsultant.online/evaluations/quote) This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist. ### Compare next steps [Orthodontist Near Me](https://virtualconsultant.online/locations/orthodontic-treatment-near-me) [Clear Aligners Near Me](https://virtualconsultant.online/treatments/clear-aligners-near-me) [Invisalign Near Me](https://virtualconsultant.online/locations/invisalign-provider-near-me) [Browse Locations](https://virtualconsultant.online/locations) ### Ready for a clearer starting point? Upload guided photos and receive an indication of likely treatment options and pricing before booking appointments. [Get an Online Quote](https://virtualconsultant.online/evaluations/quote) ### Frequently Asked Questions Is Goldenhar syndrome the same as hemifacial microsomia? They are closely related and sit on the same spectrum, known as oculo-auriculo-vertebral spectrum (OAVS). Hemifacial microsomia describes underdevelopment of the jaw, ear, and soft tissue on one side of the face. Goldenhar syndrome is generally used when eye involvement (commonly an epibulbar dermoid) and vertebral (spinal) anomalies are also present alongside the facial features. The jaw and orthodontic treatment principles are largely shared across both. Why does the jaw asymmetry in Goldenhar syndrome get more noticeable with age? The affected side of the mandible, particularly the growth centre at the jaw joint (the condyle), is often underdeveloped or structurally abnormal, so it grows more slowly than the unaffected side. Because the unaffected side continues to grow at a normal rate throughout childhood, the gap between the two sides tends to widen over time rather than staying the same, which is why the asymmetry often becomes more visible during growth spurts, particularly puberty. Will my child need jaw surgery for Goldenhar syndrome? Many children with significant mandibular involvement do need some form of jaw surgery, often starting with distraction osteogenesis in childhood to reduce asymmetry and support breathing where needed, followed by definitive orthognathic surgery once facial growth is complete in adolescence or early adulthood. The extent of surgery needed depends on the severity of the underlying skeletal difference, and some children with milder involvement are managed with orthodontics and monitoring alone. What is macrostomia and does it affect orthodontic treatment? Macrostomia is a lateral facial cleft that widens the corner of the mouth on the affected side; it is a feature in some, but not all, children with Goldenhar syndrome. It is usually repaired surgically in early childhood by a craniofacial or plastic surgery team. The repair and resulting scar tissue can affect lip and cheek muscle tension on that side, which is useful background for the orthodontic team when assessing tooth position and the pattern of any crowding. Does hearing loss from Goldenhar syndrome affect dental appointments? It can affect how information is communicated rather than the clinical treatment itself. Many children with Goldenhar syndrome have conductive hearing loss on the affected side linked to ear differences such as microtia or aural atresia. Making sure the dental or orthodontic team knows about this, facing the child when giving instructions, and confirming understanding before procedures such as scanning or impressions helps appointments run more smoothly. Can a child with Goldenhar syndrome get NHS orthodontic treatment? Yes. Children with Goldenhar syndrome in the UK are typically cared for through one of the NHS specialist craniofacial units, which include orthodontic assessment and treatment as part of a wider, funded multidisciplinary programme covering maxillofacial surgery, ENT, ophthalmology, and other specialties as needed. This is separate from and more comprehensive than a standalone NHS orthodontic referral for a straightforward malocclusion. Do vertebral anomalies in Goldenhar syndrome affect dental treatment? They can affect positioning rather than the orthodontic treatment plan itself. Some children with Goldenhar syndrome have anomalies of the neck (cervical spine), which can limit how far or safely the neck can be tilted. Flagging any diagnosed vertebral involvement to the dental team means chair positioning, and airway management under any general anaesthetic if one is ever needed, can be planned appropriately by the treating team. Explore your options Quick links Not sure where to start? 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Upload guided photos and get a tailored recommendation for your teeth and bite. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Find an Orthodontist](https://virtualconsultant.online/locations) Citation details Title Goldenhar Syndrome and Orthodontics UK Guide Publisher Virtual Consultant Online Published 2026-09-07 Updated 2026-09-07 URL [https://staging.virtualconsultant.online/guides/goldenhar-syndrome-orthodontics-uk](https://staging.virtualconsultant.online/guides/goldenhar-syndrome-orthodontics-uk)