title: Orbital soft tissue surgery for patients with Treacher-Collins or Nager syndrome. A new surgical approach with early correction of soft tissue: prospective study.
abstract: Orbitopalpebral anomalies in mandibulofacial dysostosis (Treacher-Collins syndrome) can be difficult to correct surgically and most authors recommend correction of the malar bone after the age of 8 years. We propose a new, early surgical approach for periorbital defects that involves initial implantation of autologous fat and subperiosteal malar lift with a pedicled upper eyelid flap. We prospectively studied 5 children, 3 of whom had previously had orbital reconstruction. Initial fat graft into the periorbital area was followed by a subperiosteal malar lift with lateral canthopexy, and a pedicled upper eyelid flap if needed. Two surgeons independently assessed the patients' characteristics including scleral show before and after operation, antimongoloid palpebral fissures, canthal dystopia, number 6 cleft (Tessier classification), skin quality, and surgical and ophthalmic complications. Before operation 3 patients had had ophthalmic problems. Postoperative evaluation showed improvements in scleral show, canthal dystopia, and skin quality, and correction of antimongoloid palpebral fissures and subcutaneous number 6 clefts. There were no postoperative complications. The proposed protocol gave satisfactory aesthetic and functional results in children with Treacher-Collins syndrome. We recommend that it is considered for periorbital reconstruction in all patients with a mandibulofacial deformity.
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France; Centre de Référence des Malformations Rares de la Face de la Cavite Buccale, MAFACE, 75015 Paris, France.
authors: G
authors: G
authors: Franchi
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France; Centre de Référence des Malformations Rares de la Face de la Cavite Buccale, MAFACE, 75015 Paris, France; Université Paris 5, Faculté de Médecine Paris-Descartes, 75005 Paris, France. Electronic address: natacha.kadlub@nck.aphp.fr.
authors: N
authors: N
authors: Kadlub
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France; Centre de Référence des Malformations Rares de la Face de la Cavite Buccale, MAFACE, 75015 Paris, France.
authors: P A
authors: PA
authors: Diner
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France.
authors: M
authors: M
authors: Bandini
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France; Centre de Référence des Malformations Rares de la Face de la Cavite Buccale, MAFACE, 75015 Paris, France; Université Paris 5, Faculté de Médecine Paris-Descartes, 75005 Paris, France.
authors: M-P
authors: MP
authors: Vazquez
authors: Department of Maxillofacial and Plastic Surgery, Hôpital Necker-Enfants Malades, 75015 Paris, France; Centre de Référence des Malformations Rares de la Face de la Cavite Buccale, MAFACE, 75015 Paris, France; Université Paris 5, Faculté de Médecine Paris-Descartes, 75005 Paris, France.
authors: A
authors: A
authors: Picard
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D064592:Autografts / Q000637:transplantation; D019882:Blepharoplasty / Q000379:methods; D002648:Child; D004954:Esthetics; D005143:Eyelids / Q000002:abnormalities*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008342:Mandibulofacial Dysostosis / Q000601:surgery*; D064827:Myocutaneous Flap / Q000637:transplantation; D009915:Orbit / Q000002:abnormalities* / Q000601:surgery; D010521:Periosteum / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation; D015050:Zygoma / Q000601:surgery
keywords: Fat graft transfer; Nager, mandibulofacial dysostosis; Orbital surgery; Orbitofacial cleft; Subperiosteal malar lift; Tessier Cleft; Treacher-Collins