title: Computer-assisted midface reconstruction in Treacher Collins syndrome part 1: skeletal reconstruction.
abstract: BACKGROUND
  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.
authors: Department of Plastic and Craniofacial Pediatric Surgery (Head: Guillaume Captier), Faculty of Medicine, University of Montpellier, France. Electronic address: christian.herl@free.fr.
authors: Christian
authors: C
authors: Herlin
authors: Jean Charles
authors: JC
authors: Doucet
authors: Michèle
authors: M
authors: Bigorre
authors: Hatem Cheikh
authors: HC
authors: Khelifa
authors: Guillaume
authors: G
authors: Captier
mesh_terms: D000293:Adolescent; D064592:Autografts / Q000637:transplantation; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods; D002648:Child; D003198:Computer Simulation; D017076:Computer-Aided Design; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008342:Mandibulofacial Dysostosis / Q000601:surgery*; D009915:Orbit / Q000002:abnormalities / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface; D055815:Young Adult; D015050:Zygoma / Q000002:abnormalities / Q000601:surgery*
chemical_list: D018786:Bone Substitutes
keywords: Bone grafting; Computer-assisted surgery; Franceschetti syndrome; Orbit; Presurgical simulation; Treacher Collins syndrome; Zygoma