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

Area of Science:

• Craniofacial Surgery
• Medical Imaging
• Biomedical Engineering

Background:

• Treacher Collins syndrome (TCS) causes severe craniofacial malformations, significantly impacting facial skeleton development.
• Current zygomatico-orbital reconstruction methods include autologous bone, cartilage, alloplastic implants, and free flaps.
• Neonatal airway management is critical for TCS prognosis, highlighting the need for effective reconstructive techniques.

Purpose of the Study:

• To develop a reliable, customized method for zygomatico-orbital bony reconstruction in TCS patients.
• To utilize a generic reference model tailored to individual patient morphology.
• To improve surgical outcomes for this rare and complex craniofacial syndrome.

Main Methods:

• Quantitative and qualitative analysis of the skeletal structure in four TCS patients (ages 6-20) using CT scans.
• Creation of a morphometric reference database from 40 age-matched controls.
• Application of validated craniofacial surgery software for surgical simulation and the design of patient-specific cutting and positioning guides.

Main Results:

• Significant quantitative and morphological zygomatic hypoplasia was observed in all TCS individuals.
• Orbital involvement was primarily morphological, with volumes comparable to controls.
• Customized 3D models generated from the control database facilitated the creation of precise guides for autologous bone grafts or alloplastic implants, enabling simple and reliable surgical procedures.

Conclusions:

• A reliable and reproducible skeletal reconstruction method for TCS was developed using a virtual database.
• Presurgical simulation tools are crucial for enhancing the reliability of complex craniofacial malformation surgeries.
• The customized approach ensures stable, long-term results in zygomatico-orbital reconstruction for TCS patients.