Computer-assisted midface reconstruction in Treacher Collins syndrome part 1: Skeletal reconstruction

Abstract Introduction Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation affecting the facial skeleton and soft tissues. The palate as well as the external and middle ear are also affected, but his prognosis is mainly related to neonatal airway management. Methods of z...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2013-10, Vol.41 (7), p.670-675
Main Authors: Herlin, Christian, Doucet, Jean Charles, Bigorre, Michèle, Khelifa, Hatem Cheikh, Captier, Guillaume
Format: Article
Language:English
Subjects:
Adolescent
Autografts - transplantation
Bone grafting
Bone Substitutes - therapeutic use
Bone Transplantation - instrumentation
Bone Transplantation - methods
Child
Computer Simulation
Computer-Aided Design
Computer-assisted surgery
Dentistry
Franceschetti syndrome
Humans
Image Processing, Computer-Assisted - methods
Imaging, Three-Dimensional - methods
Mandibulofacial Dysostosis - surgery
Orbit
Orbit - abnormalities
Orbit - surgery
Osteotomy - methods
Patient Care Planning
Presurgical simulation
Reconstructive Surgical Procedures - methods
Surgery
Surgery, Computer-Assisted - methods
Surgical Flaps - transplantation
Tomography, X-Ray Computed - methods
Treacher Collins syndrome
User-Computer Interface
Young Adult
Zygoma
Zygoma - abnormalities
Zygoma - surgery
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Summary:Abstract Introduction Treacher Collins syndrome (TCS) is a severe and complex craniofacial malformation affecting the facial skeleton and soft tissues. The palate as well as the external and middle ear are also affected, but his prognosis is mainly related to neonatal airway management. Methods of zygomatico-orbital reconstruction are numerous and currently use primarily autologous bone, lyophilized cartilage, alloplastic implants, or even free flaps. This work developed a reliable “customized” method of zygomatico-orbital bony reconstruction using a generic reference model tailored to each patient. Methods From a standard computed tomography (CT) acquisition, we studied qualitatively and quantitatively the skeleton of four individuals with TCS whose age was between 6 and 20 years. In parallel, we studied 40 controls at the same age to obtain a morphometric database of reference. Surgical simulation was carried out using validated software used in craniofacial surgery. Results The zygomatic hypoplasia was very important quantitatively and morphologically in all TCS individuals. Orbital involvement was mainly morphological, with volumes comparable to the controls of the same age. The control database was used to create three-dimensional computer models to be used in the manufacture of cutting guides for autologous cranial bone grafts or alloplastic implants perfectly adapted to each patient's morphology. Presurgical simulation was also used to fabricate custom positioning guides permitting a simple and reliable surgical procedure. Conclusions The use of a virtual database allowed us to design a reliable and reproducible skeletal reconstruction method for this rare and complex syndrome. The use of presurgical simulation tools seem essential in this type of craniofacial malformation to increase the reliability of these uncommon and complex surgical procedures, and to ensure stable results over time.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2013.01.007