Recurrence of Treacher Collins' syndrome with sonographic findings

Treacher Collins' syndrome, or mandibulofacial dysostosis, is a rare, autosomal-dominant disorder. We describe the recurrence of this anomaly in the fetus of a patient who previously had delivered a severely affected infant. The ultrasonographic findings of hydramnios, absence of fetal swallowing movements, and poor growth of the biparietal diameter and head circumference permitted us to suggest the diagnosis antenatally of another affected child.

[The role of 3D CT in the treatment of maxillofacial malformations]

The computed tomographic studies obtained routinely in the examination of patients with congenital defects of facial bones can be utilized as a substrate to provide an accurate three-dimensional representation of osseous abnormalities. It is a useful tool for the maxillo-facial surgeon in clinical application, in diagnosis, accurate measurements, preoperative planning and post-operative follow-up. The experience of the Division of Maxillo-Facial Surgery of Bellaria Hospital and of the Radiological Department of Instituto Rizzoli at Bologna is presented.

Imaging of ear deformities in Treacher Collins syndrome

Conductive deafness is a common feature of the Treacher Collins syndrome. The bilateral, essentially symmetrical hypoplastic deformities of middle and external ears, are characteristic. Improved imaging of the deformities using high resolution computed tomography (HRCT) has accompanied a present reluctance to explore surgically these middle ears because of poor results and the increasing success of bone anchored hearing aids. We describe the results of HRCT in 13 patients with Treacher Collins syndrome. An unpneumatized mastoid and a greatly reduced attico-antral region are almost constant findings, but a proportion of patients have a patent external auditory meatus, and, only in these is exploratory surgery feasible. Correction of ossicular deformities may be possible. Patients with atresia of the external auditory meatus are not suitable for exploration and need bone anchored hearing aids. Imaging for these children should be limited with regard to radiation dose and sedation.

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.

Sleep apnoea syndrome associated with maxillofacial abnormalities

Four cases with Obstructive Sleep Apnoea Syndrome (OSAS) are presented. They consisted of two cases with TMJ ankylosis with micrognathia, one case with Treacher Collins Syndrome, and one case with the Long Face Syndrome. Standard and specific cephalometric parameters were obtained to detect the site of the obstruction. Polysomnographic studies yielded information regarding the patient's sleep-wake state, respiratory and cardiac functioning, pre- and post-operatively. A temporary tracheostomy corrected the symptoms in one patient but the syndrome recurred when it was closed. Surgical correction of the maxillofacial anomalies will re-establish normal sleep patterns preventing OSAS.

Craniofacial osseous landmark determination from stereo computer tomography reconstructions

The accurate and reproducible determination of the three dimensional (3D) co-ordinate positions of anatomical landmarks from computer tomography (CT) images has been limited even though potentially the data have been available for several years. This paper describes a method of acquisition of osseous landmark positions using an off-line computing technique based on multiple stereo images of 3D CT reconstructions. The use of stereo pairs greatly enhances the consistent identification of osseous landmarks. Further, the technique is of particular value where access to the CT scanner is restricted due to heavy clinical demand and separate high quality graphics facilities are unavailable. Osseous landmark position data were determined for dried skulls and patients with craniofacial conditions. Accuracies of the order 1.7mm (median) were obtained. These results encourage the use of the technique for acquisition of landmark positions for the study of the craniofacial complex in three dimensions.

[Goldenhar syndrome: apropos of 2 cases]

The arc branch syndrome are a group of diseases whose classification and etiology are unknown yet. We has 2 patients with Goldenhar's syndrome and we have studied the etiopathogenicity and treatment in these diseases.

High resolution CT findings in diseases of the external auditory canal. A review of 31 cases

Thirty-one patients with pathology of the external auditory canal (EAC) were examined with high resolution CT. In this retrospective study we found that CT plays an important role in the diagnosis and especially in the determination of the extent of the disease. CT also offered us a good evaluation of the contiguous bone and it was the best method to visualize the middle ear when complete occlusion of the external auditory canal (EAC) occurred.

[Goldenhar syndrome and other ear abnormalities in HR-PCT]

The use of CT in hospitals in which also ENT departments are located will be useful in cases of osseous congenital disorders of the ear. In combination with the clinical and audiometric investigations CT of the temporal bone will be helpful for the indication of the operations to ameliorate the hearing.

The skeletal anatomy of mandibulofacial dysostosis (Treacher Collins syndrome)

Three-dimensional osseous surface re-formation imaging from CT scans was used to examine the facial skeletons of 14 living patients with mandibulofacial dysostosis. Partial to complete aplasia of the zygomatic process of the temporal bone, mild hypoplasia to aplasia of the frontal process of the zygoma, antimongoloid slant of the transverse orbital axis, and hypoplasia of the medial pterygoid plates and muscles are common to all patients examined. Deformities of the zygoma, zygomatic process of the frontal bone, mandible, and lateral pterygoid plates and muscles vary from minimal to severe, including aplasia. The body of the zygoma is the least affected part of the bone. Right-left asymmetry characterizes these deformities in all patients. The most consistent skeletal aplasia (cleft) in mandibulofacial dysostosis involves the zygomatic process of the temporal bone rather than the zygoma itself.

[Facio-auriculo-vertebral syndrome: description of a case]

The authors report the case of a fourteen months old girl who presented with emisomal, uropoietic and vertebral anomalies associated with neurologic handicap. These features can be considered characteristic of facio-auriculo-vertebral spectrum. This syndrome was not frequently described in Italian pediatric literature.

Applications of computer graphics in craniofacial surgery

Three-dimensional surface images can be reconstructed from CT scans. These are particularly useful in the study and management of patients with congenital and acquired craniofacial deformities. The principles of 3-D reformation, the production of the surface images, and recent advances in modification of these images for specific clinical needs are presented.

Three-dimensional CT reformation in children

Three-dimensional computed tomographic (CT) reformation has proven useful in the evaluation of congenital malformations of the brain as well as in the surgical approach and postoperative assessment of craniofacial anomalies in children. This technique was performed on 41 patients, of whom eight are presented. The congenital anomalies of semilobar holoprosencephaly and colpocephaly are described. Six representative cases of craniofacial anomalies with pre- and postoperative examinations include Crouzon syndrome, orbital fibrous dysplasia, frontonasal encephalocele, cranial involvement from neurofibromatosis, Treacher-Collins syndrome, and a Tessier III facial cleft. Addition of the dimension of depth provides a view heretofore not obtainable by standard imaging techniques and allows more accurate diagnosis as well as a more specific approach to surgical planning and follow-up.

[3-dimensional display of computed tomographic studies of craniofacial anomalies]

Craniofacial anomalies are conventionally investigated by cephalometry using ordinary radiographs and by computed tomography. Both methods have the major disadvantage of trying to demonstrate a complex three-dimensional structure, such as the skull, in two dimensions and they therefore cannot display a true spatial image. We present the principle underlying a three-dimensional display derived from computer tomographic studies and discuss the clinical application in the diagnosis of craniofacial anomalies.

CT in the evaluation of the orbit and the bony interorbital distance

The distance between the orbits and their individual dimensions are important in the diagnosis of craniofacial anomalies. Most observers rely on standard radiographs for measuring the bony interorbital distance. Tomography of the skull base and orbital computed tomography (CT) can also be used. This article describes the normal range of the bony interorbital distance and other useful orbital linear and angular measurements as determined from a series of CT scans of the orbits in 400 adults who had CT for other purposes. The normal interorbital distance measured at the posterior border of the frontal processes of the maxilla on nonrotated scans, in the plane of the optic nerve, ranges from 2.29 to 3.21 cm (average, 2.67 cm) in men and 2.29 to 3.20 cm (average, 2.56 cm) in women. The widest interorbital distance lies behind the posterior poles of the globes. This ranges from 3.16 to 4.10 cm (average, 3.37 cm) in men and 2.93 to 3.67 cm (average, 3.20 cm) in women.

François' syndrome. An intermediate between mandibulofacial and craniofacial dysostoses

Because of the presence of microphthalmos and cataract and the absence of auricular deformations the François syndrome belongs to neither the craniofacial nor the mandibulofacial dysostoses. TeleXray measurements revealed forward dislocation of the mandibular joint. A proposal to speak of basocraniofacial dysostosis in the cases of Hallermann-Streiff-François is made.

Radiographic features of the ear-related developmental anomalies in patients with mandibulofacial dysostosis

Among the conditions that arise from disturbances in development of the first two branchial arches, the symmetric syndrome of mandibulofacial dysostosis and the asymmetric anomalies of the hemicraniofacial microsomia represent a characteristic pattern of craniofacial malformation distinct from other first and second arch syndromes. Since the usual embryonic aberration in both of these anomalies involves the first and second branchial arch derivatives, malformations of the external and middle ear are common. The external auditory canal is absent in the vast majority of the cases. Incudomallear deformities are usually present. In this paper, radiographic analysis of the ear-related developmental anomalies of 17 patients with mandibulofacial dysostosis is described.