Surgical correction of the Treacher Collins malar deficiency: quantitative CT scan analysis of long-term results

This paper describes an alternative means of reconstruction of the Treacher Collins zygomatic deficiency and presents a consecutive patient series with long-term follow-up documented by clinical and quantitative means employing CT-derived craniofacial skeletal measurements. Eight children (mean age at operation 10.5 years) underwent bilateral zygomatic reconstruction with full-thickness, T-shaped calvarial bone grafts contoured three-dimensionally and then inset and stabilized with plate-and-screw fixation, with exposure provided only by a coronal incision. Orbital floor defects and graft donor sites were repaired with fixed split-thickness cranial bone. No complications occurred during surgery, and donor sites healed without clinical defect. Zygomatic augmentation was achieved in all patients, with follow-up ranging from 24 to 50 months (mean 35 months). CT scanning done before surgery, immediately afterward, and again 1 year or more later demonstrated significant increases in lateral orbital wall length, lateral orbital distance, interzygomatic arch distance, and zygomatic arch length. The late postoperative scans showed that these changes were maintained. However, effective treatment of the surrounding soft-tissue and eyelid deficiencies remains an unsolved problem.