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Imahiyerobo TA, Valenti AB, Guadix S, LaValley M, Asadourian PA, Buontempo M, Souweidane M, Hoffman C. The Role of Virtual Surgical Planning in Surgery for Complex Craniosynostosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5524. [PMID: 38204873 PMCID: PMC10781142 DOI: 10.1097/gox.0000000000005524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024]
Abstract
Background Virtual surgical planning (VSP) decreases reliance on intraoperative subjective assessment of aesthetic and functional outcomes in craniofacial surgery. Here, we describe our experience of using VSP for complex craniosynostosis surgery to inform preoperative decision making and optimize postoperative outcomes. Methods Chart review was performed for children treated with craniosynostosis at our institution from 2015 to 2021. Eight VSP maneuvers were defined and assigned to each patient when applicable: (1) complex cranioplasty: combined autologous and synthetic; (2) autologous cranioplasty; (3) synthetic cranioplasty; (4) vector analysis and distractor placement; (5) complex osteotomies; (6) multilayered intraoperative plans; (7) volume analysis; and (8) communication with parents. Outcomes between VSP and non-VSP cohorts were compared. Results Of 166 total cases, 32 were considered complex, defined by multisutural craniosynostosis, syndromic craniosynostosis, or revision status. Of these complex cases, 20 underwent VSP and 12 did not. There was no difference in mean operative time between the VSP and non-VSP groups (541 versus 532 min, P = 0.82) or in unexpected return to operating room (10.5% versus 8.3%, P = 0.84). VSP was most often used to communicate the surgical plan with parents (90%) and plan complex osteotomies (85%). Conclusions In this cohort, VSP was most often used to communicate the surgical plan with families and plan complex osteotomies. Our results indicate that VSP may improve intraoperative efficiency and safety for complex craniosynostosis surgery. This tool can be considered a useful adjunct to plan and guide intraoperative decisions in complex cases, reducing variability and guiding parental expectations.
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Affiliation(s)
- Thomas A. Imahiyerobo
- From the Department of Plastic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
- Department of Plastic Surgery, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Alyssa B. Valenti
- From the Department of Plastic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
- Department of Plastic Surgery, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Sergio Guadix
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
| | - Myles LaValley
- Department of Plastic Surgery, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Paul A. Asadourian
- Department of Plastic Surgery, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, N.Y
| | - Michelle Buontempo
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
| | - Mark Souweidane
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
| | - Caitlin Hoffman
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, N.Y
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Patient-specific Composite Anatomic Models: Improving the Foundation for Craniosynostosis Repair. J Craniofac Surg 2023; 34:1078-1081. [PMID: 36727996 DOI: 10.1097/scs.0000000000009182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/15/2022] [Indexed: 02/03/2023] Open
Abstract
Preoperative surgical planning incorporating computer-aided design and manufacturing is increasingly being utilized today within the fields of craniomaxillofacial, orthopedic, and neurosurgery. Application of these techniques for craniosynostosis reconstruction can include patient-specific anatomic reference models, "normal" reference models or patient-specific cutting/marking guides based on the presurgical plan. The major challenge remains the lack of tangible means to transfer the preoperative plan to the operating table. We propose a simple solution to utilize a digitally designed, 3D-printed "composite model" as a structural template for cranial vault reconstruction. The composite model is generated by merging the abnormal patient cranial anatomy with the "dural surface topography" of an age-matched, sex-matched, and ethnicity-matched normative skull model. We illustrate the applicability of this approach in 2 divergent cases: 22-month-old African American male with sagittal synostosis and 5-month-old White male with metopic synostosis. The aim of this technical report is to describe our application of this computer-aided design and modeling workflow for the creation of practical 3D-printed skulls that can serve as intraoperative frameworks for the correction of craniosynostosis. With success in our first 2 cases, we believe this approach of a composite model is another step in reducing our reliance on subjective guesswork, and the fundamental aspect of the workflow has a wider application within the field of craniofacial surgery for both clinical patient care and education.
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Paré A, Charbonnier B, Veziers J, Vignes C, Dutilleul M, De Pinieux G, Laure B, Bossard A, Saucet-Zerbib A, Touzot-Jourde G, Weiss P, Corre P, Gauthier O, Marchat D. Standardized and axially vascularized calcium phosphate-based implants for segmental mandibular defects: A promising proof of concept. Acta Biomater 2022; 154:626-640. [PMID: 36210043 DOI: 10.1016/j.actbio.2022.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
The reconstruction of massive segmental mandibular bone defects (SMDs) remains challenging even today; the current gold standard in human clinics being vascularized bone transplantation (VBT). As alternative to this onerous approach, bone tissue engineering strategies have been widely investigated. However, they displayed limited clinical success, particularly in failing to address the essential problem of quick vascularization of the implant. Although routinely used in clinics, the insertion of intrinsic vascularization in bioengineered constructs for the rapid formation of a feeding angiosome remains uncommon. In a clinically relevant model (sheep), a custom calcium phosphate-based bioceramic soaked with autologous bone marrow and perfused by an arteriovenous loop was tested to regenerate a massive SMD and was compared to VBT (clinical standard). Animals did not support well the VBT treatment, and the study was aborted 2 weeks after surgery due to ethical and animal welfare considerations. SMD regeneration was successful with the custom vascularized bone construct. Implants were well osseointegrated and vascularized after only 3 months of implantation and totally entrapped in lamellar bone after 12 months; a healthy yellow bone marrow filled the remaining space. STATEMENT OF SIGNIFICANCE: Regenerative medicine struggles with the generation of large functional bone volume. Among them segmental mandibular defects are particularly challenging to restore. The standard of care, based on bone free flaps, still displays ethical and technical drawbacks (e.g., donor site morbidity). Modern engineering technologies (e.g., 3D printing, digital chain) were combined to relevant surgical techniques to provide a pre-clinical proof of concept, investigating for the benefits of such a strategy in bone-related regenerative field. Results proved that a synthetic-biologics-free approach is able to regenerate a critical size segmental mandibular defect of 15 cm3 in a relevant preclinical model, mimicking real life scenarii of segmental mandibular defect, with a full physiological regeneration of the defect after 12 months.
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Affiliation(s)
- Arnaud Paré
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France; Department of Maxillofacial and Plastic surgery, Burn Unit, University Hospital of Tours, Trousseau Hospital, Avenue de la République, Chambray lès Tours 37170, France
| | - Baptiste Charbonnier
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France; Mines Saint-Étienne, Univ Jean Monnet, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Joëlle Veziers
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France
| | - Caroline Vignes
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France
| | - Maeva Dutilleul
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France
| | - Gonzague De Pinieux
- Department of Pathology, University Hospital of Tours, Trousseau Hospital, Avenue de la République, Chambray lès Tours 37170, France
| | - Boris Laure
- Department of Maxillofacial and Plastic surgery, Burn Unit, University Hospital of Tours, Trousseau Hospital, Avenue de la République, Chambray lès Tours 37170, France
| | - Adeline Bossard
- ONIRIS Nantes-Atlantic College of Veterinary Medicine, Research Center of Preclinical Invesitagtion (CRIP), Site de la Chantrerie, 101 route de Gachet, Nantes 44307, France
| | - Annaëlle Saucet-Zerbib
- ONIRIS Nantes-Atlantic College of Veterinary Medicine, Research Center of Preclinical Invesitagtion (CRIP), Site de la Chantrerie, 101 route de Gachet, Nantes 44307, France
| | - Gwenola Touzot-Jourde
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France; ONIRIS Nantes-Atlantic College of Veterinary Medicine, Research Center of Preclinical Invesitagtion (CRIP), Site de la Chantrerie, 101 route de Gachet, Nantes 44307, France
| | - Pierre Weiss
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France
| | - Pierre Corre
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France; Clinique de Stomatologie et Chirurgie Maxillo-Faciale, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes 44042, France
| | - Olivier Gauthier
- INSERM, U 1229, Laboratory of Regenerative Medicine and Skeleton, RMeS, Nantes Université, 1 Place Alexis Ricordeau, Nantes 44042, France; ONIRIS Nantes-Atlantic College of Veterinary Medicine, Research Center of Preclinical Invesitagtion (CRIP), Site de la Chantrerie, 101 route de Gachet, Nantes 44307, France
| | - David Marchat
- Mines Saint-Étienne, Univ Jean Monnet, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France.
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Lethaus B, Gruichev D, Gräfe D, Bartella AK, Hahnel S, Yovev T, Pausch NC, Krause M. "Black bone": the new backbone in CAD/CAM-assisted craniosynostosis surgery? Acta Neurochir (Wien) 2021; 163:1735-1741. [PMID: 32519160 PMCID: PMC8116246 DOI: 10.1007/s00701-020-04445-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. However, until now, computed tomography (CT) scans with ionizing radiation were necessary to plan the procedure and create guiding templates. The purpose of this study was to present our series using CAD/CAM techniques in planning and conducting fronto-orbital advancement surgery in patients with trigonocephaly with datasets acquired only by "black bone" magnetic resonance imaging (MRI). METHODS Six consecutively operated cases from 2019 were included in this study. All patients suffered from non-syndromic trigonocephaly with no primary surgeries. All patients underwent cranial MRI including black bone sequences. Preoperative planning and guides were created based on the DICOM datasets. We analyzed demographic data, clinical data, and outcome measured by Whitaker score. RESULTS In all cases, precise frontobasal advancement was possible with the CAD/CAM guides created by black bone MRI. The mean operation time and planning time were 222 and 32 min. The time on intensive and intermediate care unit (ICU/IMC) time was 4.5 days, respectively. All but one case were classified as Whitaker I. CONCLUSION In trigonocephaly treatment by frontobasal advancement, black bone MRI-based CAD/CAM craniosynostosis surgery is safe and feasible. It offers the major advantage of completely avoiding CT scans and ionizing radiation with superior imaging quality of intracranial structures. Thus, it improves intraoperative safety and-at the same time-has the potential to reduce operating room (OR) time.
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Affiliation(s)
- Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany.
| | - Dimitar Gruichev
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
| | - Daniel Gräfe
- Department of Paediatric Radiology, Leipzig University, Liebigstraße 14, 04103, Leipzig, Germany
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
| | - Sebastian Hahnel
- Department of Prosthodontics and Materials Science, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
| | - Tsanko Yovev
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
| | - Niels Christian Pausch
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany
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Kulker D, Louisy A, Listrat A, Travers N, Pare A, Laure B. Is reverse frontal cranioplasty eligible for the correction of both the forehead deformities and the intracranial hypertension in craniosynostosis? Comparison of the preoperative and postoperative intracranial volumes. J Craniomaxillofac Surg 2021; 49:815-822. [PMID: 34217566 DOI: 10.1016/j.jcms.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/21/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND This study aimed to describe the surgical technique of reverse frontal cranioplasty (RFC), the aesthetical modification as well as the modification of intracranial volume (ICV) to assess its potential eligibility for the treatment of the intracranial hypertension (IH). MATERIALS AND METHODS A retrospective monocentric study included the patients with a history of craniosynostosis with a forehead deformity who underwent RFC. A subjective outcome questionnaire (SOQ) was conducted with each patient or their parent to determine their level of satisfaction after RFC. Pre- and postoperative computed tomography (CT) scans were analyzed and compared to investigate the ICV change and fronto-nasal angle. RESULTS Eleven patients were included in the study (6 female and 5 male) with a mean age of 10.9 years old (range 3-23 years) and an average follow-up of 4.5 years (1-11 years). All patients responded to the questionnaire with a high level of overall satisfaction (mean 9.1/10). The mean preoperative FNA was 134° ± 5° while the mean postoperative angle was 126.4° ± 6, corresponding to an average decrease of 7.6° (95% CI, 4.0-11.2°; p < 0.001). One patient with preoperative IH had a clinical recurrence during the follow-up. The ICV was significantly higher after the surgery (p < 0.0001), with an average increase of 3.2% (95% CI, 2.3-4.1%). CONCLUSION Reverse (RFC) is a useful technique for the correction of the frontal malformations related to craniosynostosis, such as a sloping forehead and/or a lack of the supraorbital projection. Regarding the limited gain of intracranial volume (ICV), it should not be used alone as primary cranial expansion surgery for craniosynostosis with intracranial hypertension (IH).
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Affiliation(s)
- D Kulker
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France.
| | - A Louisy
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France
| | - A Listrat
- Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
| | - N Travers
- Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
| | - A Pare
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France
| | - B Laure
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France; Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
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Frank N, Beinemann J, Thieringer FM, Benitez BK, Kunz C, Guzman R, Soleman J. The need for overcorrection: evaluation of computer-assisted, virtually planned, fronto-orbital advancement using postoperative 3D photography. Neurosurg Focus 2021; 50:E5. [PMID: 33794499 DOI: 10.3171/2021.1.focus201026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main indication for craniofacial remodeling of craniosynostosis is to correct the deformity, but potential increased intracranial pressure resulting in neurocognitive damage and neuropsychological disadvantages cannot be neglected. The relapse rate after fronto-orbital advancement (FOA) seems to be high; however, to date, objective measurement techniques do not exist. The aim of this study was to quantify the outcome of FOA using computer-assisted design (CAD) and computer-assisted manufacturing (CAM) to create individualized 3D-printed templates for correction of craniosynostosis, using postoperative 3D photographic head and face surface scans during follow-up. METHODS The authors included all patients who underwent FOA between 2014 and 2020 with individualized, CAD/CAM-based, 3D-printed templates and received postoperative 3D photographic face and head scans at follow-up. Since 2016, the authors have routinely planned an additional "overcorrection" of 3 mm to the CAD-based FOA correction of the affected side(s). The virtually planned supraorbital angle for FOA correction was compared with the postoperative supraorbital angle measured on postoperative 3D photographic head and face surface scans. The primary outcome was the delta between the planned CAD/CAM FOA correction and that achieved based on 3D photographs. Secondary outcomes included outcomes with and those without "overcorrection," time of surgery, blood loss, and morbidity. RESULTS Short-term follow-up (mean 9 months after surgery; 14 patients) showed a delta of 12° between the planned and achieved supraorbital angle. Long-term follow-up (mean 23 months; 8 patients) showed stagnant supraorbital angles without a significant increase in relapse. Postsurgical supraorbital angles after an additionally planned overcorrection (of 3 mm) of the affected side showed a mean delta of 11° versus 14° without overcorrection. The perioperative and postoperative complication rates of the whole cohort (n = 36) were very low, and the mean (SD) intraoperative blood loss was 128 (60) ml with a mean (SD) transfused red blood cell volume of 133 (67) ml. CONCLUSIONS Postoperative measurement of the applied FOA on 3D photographs is a feasible and objective method for assessment of surgical results. The delta between the FOA correction planned with CAD/CAM and the achieved correction can be analyzed on postoperative 3D photographs. In the future, calculation of the amount of "overcorrection" needed to avoid relapse of the affected side(s) after FOA may be possible with the aid of these techniques.
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Affiliation(s)
| | - Joerg Beinemann
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel
| | | | - Benito K Benitez
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel.,5Department of Clinical Research, University of Basel, Switzerland
| | - Christoph Kunz
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel.,4Faculty of Medicine and
| | - Raphael Guzman
- Departments of1Neurosurgery and.,3Division of Pediatric Neurosurgery, University Children's Hospital of Basel; and.,4Faculty of Medicine and
| | - Jehuda Soleman
- Departments of1Neurosurgery and.,3Division of Pediatric Neurosurgery, University Children's Hospital of Basel; and.,4Faculty of Medicine and
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Batut C, Paré A, Kulker D, Listrat A, Laure B. How Accurate Is Computer-Assisted Orbital Hypertelorism Surgery? Comparison of the Three-Dimensional Surgical Planning with the Postoperative Outcomes. Facial Plast Surg Aesthet Med 2020; 22:433-440. [DOI: 10.1089/fpsam.2020.0129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Claire Batut
- Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
- Department of Maxillofacial and Plastic Surgery, Trousseau Hospital, Tours University Hospital, Tours, France
| | - Arnaud Paré
- Department of Maxillofacial and Plastic Surgery, Trousseau Hospital, Tours University Hospital, Tours, France
- Shiley Center of Orthopedic Research and Education, La Jolla, California, USA
| | - Dimitri Kulker
- Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
- Department of Maxillofacial and Plastic Surgery, Trousseau Hospital, Tours University Hospital, Tours, France
| | - Antoine Listrat
- Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
- Department of Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
| | - Boris Laure
- Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
- Department of Maxillofacial and Plastic Surgery, Trousseau Hospital, Tours University Hospital, Tours, France
- Department of Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France
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