title: Treacher Collins Syndrome: A Systematic Review of Evidence-Based Treatment and Recommendations.
abstract: BACKGROUND
  No reviews or guidelines are available on evidence-based treatment for the multidisciplinary approach in Treacher Collins syndrome. The authors' aim is to provide an evidence-based review of multidisciplinary treatment of Treacher Collins syndrome based on levels of evidence and supported with graded recommendations.
  
  
  METHODS
  A systematic search was performed by means of the PubMed, Web-of-Science, Embase, and Cochrane Central databases (1985 to January of 2014). Included were clinical studies (with five or more Treacher Collins syndrome patients) related to therapy, diagnosis, or risk of concomitant diseases. Level of evidence of the selected articles was rated according to the American Society of Plastic Surgeons evidence-based clinical practice guidelines. After two panelists had reviewed each abstract separately, a consensus method was used to solve any disagreements concerning article inclusion.
  
  
  RESULTS
  Of the 2433 identified articles, 63 studies (Level of Evidence II through V) were included. Conclusions and recommendations were extracted consecutively for the following items: upper airway; ear, hearing, and speech; the eye, eyelashes, and lacrimal system; growth, feeding, and swallowing; the nose; psychosocial factors; and craniofacial reconstruction.
  
  
  CONCLUSIONS
  In this systematic review, current evidence for the multidisciplinary treatment of Treacher Collins syndrome is provided, recommendations for treatment are made, and a proposed algorithm for treatment is presented. Although some topics are well supported, others, especially ocular, nasal, speech, feeding, and swallowing problems, lack sufficient evidence. In addition, craniofacial surgical reconstruction lacks a sufficient level of evidence to provide a sound basis for a full treatment protocol. Despite the rarity of the syndrome, more research is needed to compare outcomes of several surgical treatments, especially in orbitozygomatic/maxillary regions.
authors.affiliation: Rotterdam, The Netherlands From the Departments of Plastic, Reconstructive and Hand Surgery, Oral and Maxillofacial Surgery, and Pediatric Intensive Care, Sophia Children's Hospital, and the Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Plomp
authors.forename: Manouk J S
authors.initials: MJS
authors.lastname: van Lieshout
authors.forename: Koen F M
authors.initials: KFM
authors.lastname: Joosten
authors.forename: Eppo B
authors.initials: EB
authors.lastname: Wolvius
authors.forename: Marc P
authors.initials: MP
authors.lastname: van der Schroeff
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Versnel
authors.forename: René M L
authors.initials: RML
authors.lastname: Poublon
authors.forename: Irene M J
authors.initials: IMJ
authors.lastname: Mathijssen
mesh_terms: D003131:Combined Modality Therapy; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008342:Mandibulofacial Dysostosis / Q000175:diagnosis / Q000628:therapy*; D009426:Netherlands; D010347:Patient Care Planning / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D035583:Rare Diseases; D012720:Severity of Illness Index; D016896:Treatment Outcome