Dental Management of a 21-Year-Old Thai Female with Goldenhar Syndrome Requiring Special Dental Care: A Case Report

Abstract

Goldenhar syndrome is a congenital craniofacial disorder with heterogeneous clinical manifestations, including facial asymmetry and abnormalities of the ears, eyes, jaws, and hearing. This report describes the dental management of a 21-year-old Thai woman diagnosed with Goldenhar syndrome and congenital bilateral hearing impairment. Her medical history included well-controlled epilepsy and asthma. Extraoral examination revealed hemifacial microsomia, facial asymmetry, maxillary and mandibular hypoplasia, widened oral commissure, incompetent lip closure, and abnormalities of the ears and eyes. Intraoral examination revealed dental caries in teeth 13, 24, and 46; deep pits and fissures in teeth 16, 17, 26, and 27; an embedded tooth 45; impacted teeth 38 and 48; Class II malocclusion with an open bite; and plaque-induced gingivitis. Dental management was provided within a special care dentistry framework. Systemic risks were assessed, communication strategies were adapted to the patient’s hearing impairment, and her caregiver assisted with communication. Treatment included scaling, oral hygiene instruction, fluoride varnish application, tooth-colored restorations, and pit and fissure sealants. At 1 year and 7 months after treatment initiation, her overall oral health had improved, and no new caries were detected. However, increased plaque accumulation at some sites and partial deterioration of several sealants were observed during follow-up. Professional cleaning, reinforcement of oral hygiene practices, and resealing were therefore provided as indicated. This case highlights the importance of patient-centered care, individualized communication, caregiver involvement, preventive dentistry, and long-term follow-up in the dental management of patients with Goldenhar syndrome who require special dental care.