Treacher Collins syndrome: early surgical treatment of orbitomalar malformations

In the past various materials have been used for the correction of the malar bone defect, such as cartilage, dermis fat, silicone, autograft, homograft, xenograft, and free bone transplantation. The disadvantages of inorganic implants are well known: dislocation, extrusion, and capsular contraction. The bony autograft has no growth potential, and children may need several complementary corrections. None of these procedures is totally satisfactory. To solve these problems malar reconstruction is performed with the help of a temporal bone flap. Two varieties of these flaps have been described: one anteriorly with a muscular pedicle vascularized by the deep temporal artery and one posteriorly with a galeal pedicle vascularized by the superficial temporal artery. The main advantage of an osteomuscular flap is the survival of bone once it has been transferred. The second advantage is related to the osteogenic potential of the cambium layer of the periosteum, which may prove to be an ongoing concern. Our series of patients includes 20 children. Correction of the eyelid coloboma was obtained by transposition and advancement of a superior palpebral flap.