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He KH, Bruse JL, Rodriguez-Florez N, Dunaway D, Jeelani O, Schievano S, Borghi A. Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231158. [PMID: 38577216 PMCID: PMC10987985 DOI: 10.1098/rsos.231158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024]
Abstract
Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn's head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull-distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.
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Affiliation(s)
- K. H. He
- Ningbo University, Ningbo, People's Republic of China
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J. L. Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - N. Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, San Sebastian, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - D. Dunaway
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - O. Jeelani
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - A. Borghi
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Engineering, Durham University, Durham, UK
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Correlation between head shape and volumetric changes following spring-assisted posterior vault expansion. J Craniomaxillofac Surg 2021; 50:343-352. [DOI: 10.1016/j.jcms.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
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The turricephaly index: A validated method for recording turricephaly and its natural history in Apert syndrome. J Craniomaxillofac Surg 2019; 47:414-419. [DOI: 10.1016/j.jcms.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
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Describing the mandible in patients with craniofacial microsomia based on principal component analysis and thin plate spline video analysis. Int J Oral Maxillofac Surg 2019; 48:302-308. [DOI: 10.1016/j.ijom.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/30/2018] [Accepted: 08/02/2018] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE Data on cranial morphology of healthy individuals can be used as the guide in the treatment of cranial deformity. There are many reports analyzing the cranial morphology of healthy children in the past. But most of them focus on 2-dimensional values, and there are only a few reports, which analyzed the cranial morphology of Japanese healthy infants. We report a novel method that enables the comprehensive analysis of cranial morphology of Japanese healthy infants in 3D. METHODS Craniofacial CT data of 20 healthy infants (9 males, 11 females) ranging in age from 1 to 11 months were collected. Based on the CT data, we created 20 homologous models of cranium using software specifically designed to support homologous modeling. We averaged vertex coordinates of the homologous models to create average model. We further performed principal component analysis, and created virtual models based on each principal component. The contribution rate was calculated, and the features described by each principal component were interpreted. RESULTS We created the average cranial model of Japanese healthy infants. Seven principal components (cumulative contribution rate: 89.218%) were interpreted as to which part of the cranial shape each component was related to. The elements were extracted that may characterize the cranial morphology of some of the clinical conditions such as dolico/brachycephaly and deformational plagiocephaly. Some of these elements have not been mentioned in the past literature. CONCLUSION Homologous modeling was considered to be valid and strong tool for comprehensive analysis of cranial morphology.
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Using principal component analysis to describe the midfacial deformities in patients with craniofacial microsomia. J Craniomaxillofac Surg 2018; 46:2032-2041. [PMID: 30318324 DOI: 10.1016/j.jcms.2018.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/09/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Craniofacial microsomia (CFM) is the result of a disturbance in embryologic development and is characterised by an asymmetric, mostly unilateral facial underdevelopment. The aim of this study is to understand the midfacial involvement in CFM using principal component analysis (PCA). MATERIALS AND METHODS Pre-operative data from 19 CFM and 23 control patients were collected. A set of 71 landmarks was placed on three-dimensional (3D) reconstructions of all skulls to compare both populations. PCA visualised variation within both groups and calculated the vector of change. Linear measurements were taken to compare ratios between the populations and between the affected and unaffected sides in CFM patients. RESULTS PCA defined a vector that described shape changes between both populations. Videos showed the variation within the control and CFM group and the transformation from a mean CFM skull into a normal phenotype. Linear measurements showed a significant difference between the affected and unaffected sides in CFM patients. CONCLUSION PCA has not been applied on asymmetrical data before, but it has proved to be a useful method to describe CFM. The virtual normalisation of a mean CFM skull enables visualisation of the bony shape changes, which is promising to delineate and to plan surgical correction and could be used as an outcome measure.
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Rodriguez-Florez N, Bruse JL, Borghi A, Vercruysse H, Ong J, James G, Pennec X, Dunaway DJ, Jeelani NUO, Schievano S. Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty. Int J Comput Assist Radiol Surg 2017; 12:1739-1749. [PMID: 28550406 PMCID: PMC5608871 DOI: 10.1007/s11548-017-1614-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/16/2017] [Indexed: 12/04/2022]
Abstract
PURPOSE Spring-assisted cranioplasty is performed to correct the long and narrow head shape of children with sagittal synostosis. Such corrective surgery involves osteotomies and the placement of spring-like distractors, which gradually expand to widen the skull until removal about 4 months later. Due to its dynamic nature, associations between surgical parameters and post-operative 3D head shape features are difficult to comprehend. The current study aimed at applying population-based statistical shape modelling to gain insight into how the choice of surgical parameters such as craniotomy size and spring positioning affects post-surgical head shape. METHODS Twenty consecutive patients with sagittal synostosis who underwent spring-assisted cranioplasty at Great Ormond Street Hospital for Children (London, UK) were prospectively recruited. Using a nonparametric statistical modelling technique based on mathematical currents, a 3D head shape template was computed from surface head scans of sagittal patients after spring removal. Partial least squares (PLS) regression was employed to quantify and visualise trends of localised head shape changes associated with the surgical parameters recorded during spring insertion: anterior-posterior and lateral craniotomy dimensions, anterior spring position and distance between anterior and posterior springs. RESULTS Bivariate correlations between surgical parameters and corresponding PLS shape vectors demonstrated that anterior-posterior (Pearson's [Formula: see text]) and lateral craniotomy dimensions (Spearman's [Formula: see text]), as well as the position of the anterior spring ([Formula: see text]) and the distance between both springs ([Formula: see text]) on average had significant effects on head shapes at the time of spring removal. Such effects were visualised on 3D models. CONCLUSIONS Population-based analysis of 3D post-operative medical images via computational statistical modelling tools allowed for detection of novel associations between surgical parameters and head shape features achieved following spring-assisted cranioplasty. The techniques described here could be extended to other cranio-maxillofacial procedures in order to assess post-operative outcomes and ultimately facilitate surgical decision making.
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Affiliation(s)
- Naiara Rodriguez-Florez
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Jan L Bruse
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Herman Vercruysse
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N U Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
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Schaal SC, Ruff C, Pluijmers BI, Pauws E, Looman CWN, Koudstaal MJ, Dunaway DJ. Characterizing the skull base in craniofacial microsomia using principal component analysis. Int J Oral Maxillofac Surg 2017; 46:1656-1663. [PMID: 28774693 DOI: 10.1016/j.ijom.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/23/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
Abstract
The aim of this study was to compare the anatomical differences in the skull base between the affected and non-affected side in patients with craniofacial microsomia (CFM), and to compare the affected and non-affected sides with measurements from a normal population. Three-dimensional computed tomography scans of 13 patients with unilateral CFM and 19 normal patients (age range 7-12 years) were marked manually with reliable homologous landmarks. Principal component analysis (PCA), as part of a point distribution model (PDM), was used to analyse the variability within the normal and preoperative CFM patient groups. Through analysis of the differences in the principal components calculated for the two groups, a model was created to describe the differences between CFM patients and normal age-matched controls. The PDMs were also used to describe the shape changes in the skull base between the cohorts and validated this model. Using thin-plate splines as a means of interpolation, videos were created to visualize the transformation from CFM skull to normal skull, and to display the variability in shape changes within the groups themselves. In CFM cases, the skull base showed significant asymmetry. Anatomical areas around the glenoid fossa and mastoid process showed the most asymmetry and restriction of growth, suggesting a pathology involving the first and second pharyngeal arches.
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Affiliation(s)
- S C Schaal
- The Craniofacial Unit, Great Ormond Street Hospital Institute of Child Health, London, UK.
| | - C Ruff
- Medical Physics Department, University College London, London, UK
| | - B I Pluijmers
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - E Pauws
- Department of Developmental Biology and Cancer Programme, UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - C W N Looman
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M J Koudstaal
- The Craniofacial Unit, Great Ormond Street Hospital Institute of Child Health, London, UK; Medical Physics Department, University College London, London, UK
| | - D J Dunaway
- The Craniofacial Unit, Great Ormond Street Hospital Institute of Child Health, London, UK
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Dall'Asta A, Schievano S, Bruse JL, Paramasivam G, Kaihura CT, Dunaway D, Lees CC. Quantitative analysis of fetal facial morphology using 3D ultrasound and statistical shape modeling: a feasibility study. Am J Obstet Gynecol 2017; 217:76.e1-76.e8. [PMID: 28209493 DOI: 10.1016/j.ajog.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The antenatal detection of facial dysmorphism using 3-dimensional ultrasound may raise the suspicion of an underlying genetic condition but infrequently leads to a definitive antenatal diagnosis. Despite advances in array and noninvasive prenatal testing, not all genetic conditions can be ascertained from such testing. OBJECTIVES The aim of this study was to investigate the feasibility of quantitative assessment of fetal face features using prenatal 3-dimensional ultrasound volumes and statistical shape modeling. STUDY DESIGN: Thirteen normal and 7 abnormal stored 3-dimensional ultrasound fetal face volumes were analyzed, at a median gestation of 29+4 weeks (25+0 to 36+1). The 20 3-dimensional surface meshes generated were aligned and served as input for a statistical shape model, which computed the mean 3-dimensional face shape and 3-dimensional shape variations using principal component analysis. RESULTS Ten shape modes explained more than 90% of the total shape variability in the population. While the first mode accounted for overall size differences, the second highlighted shape feature changes from an overall proportionate toward a more asymmetric face shape with a wide prominent forehead and an undersized, posteriorly positioned chin. Analysis of the Mahalanobis distance in principal component analysis shape space suggested differences between normal and abnormal fetuses (median and interquartile range distance values, 7.31 ± 5.54 for the normal group vs 13.27 ± 9.82 for the abnormal group) (P = .056). CONCLUSION This feasibility study demonstrates that objective characterization and quantification of fetal facial morphology is possible from 3-dimensional ultrasound. This technique has the potential to assist in utero diagnosis, particularly of rare conditions in which facial dysmorphology is a feature.
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Affiliation(s)
- Andrea Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom; Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Silvia Schievano
- University College London Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jan L Bruse
- University College London Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - David Dunaway
- Craniofacial Unit, Great Ormond Street Hospital for Children National Health Service Foundation Trust and University College London Hospital, London, United Kingdom
| | - Christoph C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom; Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Evaluating the Efficacy of Monobloc Distraction in the Crouzon-Pfeiffer Craniofacial Deformity Using Geometric Morphometrics. Plast Reconstr Surg 2017; 139:477e-487e. [DOI: 10.1097/prs.0000000000003016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Staal FCR, Ponniah AJT, Angullia F, Ruff C, Koudstaal MJ, Dunaway D. Describing Crouzon and Pfeiffer syndrome based on principal component analysis. J Craniomaxillofac Surg 2015; 43:528-36. [PMID: 25792443 DOI: 10.1016/j.jcms.2015.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022] Open
Abstract
UNLABELLED Crouzon and Pfeiffer syndrome are syndromic craniosynostosis caused by specific mutations in the FGFR genes. Patients share the characteristics of a tall, flattened forehead, exorbitism, hypertelorism, maxillary hypoplasia and mandibular prognathism. Geometric morphometrics allows the identification of the global shape changes within and between the normal and syndromic population. METHODS Data from 27 Crouzon-Pfeiffer and 33 normal subjects were landmarked in order to compare both populations. With principal component analysis the variation within both groups was visualized and the vector of change was calculated. This model normalized a Crouzon-Pfeiffer skull and was compared to age-matched normative control data. RESULTS PCA defined a vector that described the shape changes between both populations. Movies showed how the normal skull transformed into a Crouzon-Pfeiffer phenotype and vice versa. Comparing these results to established age-matched normal control data confirmed that our model could normalize a Crouzon-Pfeiffer skull. CONCLUSIONS PCA was able to describe deformities associated with Crouzon-Pfeiffer syndrome and is a promising method to analyse variability in syndromic craniosynostosis. The virtual normalization of a Crouzon-Pfeiffer skull is useful to delineate the phenotypic changes required for correction, can help surgeons plan reconstructive surgery and is a potentially promising surgical outcome measure.
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Affiliation(s)
| | | | | | - Clifford Ruff
- Medical Physics Department, University College London, London, United Kingdom
| | - Maarten J Koudstaal
- Great Ormond Street Hospital, London, United Kingdom; Erasmus Medical Center, Maxillofacial Surgery, Rotterdam, The Netherlands
| | - David Dunaway
- Great Ormond Street Hospital, London, United Kingdom
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Crombag GAJC, Verdoorn MHAS, Nikkhah D, Ponniah AJT, Ruff C, Dunaway D. Assessing the corrective effects of facial bipartition distraction in Apert syndrome using geometric morphometrics. J Plast Reconstr Aesthet Surg 2014; 67:e151-61. [PMID: 24709088 DOI: 10.1016/j.bjps.2014.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Apert syndrome is a congenital disorder characterized by craniosynostosis and midface hypoplasia. This study looks to identify to what extent bipartition distraction corrects the morphological abnormalities of this condition. Preoperative and postoperative three-dimensional computed tomography (3DCT) scans of 10 patients with Apert syndrome (12-21 years) were identified from the Great Ormond Street Hospital database. To analyse preoperative and postoperative scans, 98 landmarks and 13 normal skulls were used. Principal component analysis (PCA) was used to analyse patterns in the datasets. Within each group, eigenvectors were identified that demonstrated the aspects of the skull where most variations were found. The analysis allowed both global shape measurement and local proportions. Postoperative and normal scans both showed the same first three principal components. Warping from preoperative to postoperative illustrates midface advancement and inward rotation of the orbits. Postoperative to normal warps demonstrate some remaining differences. The reliability of the used land marks varied between 77% and 95% for the highly reproducible landmarks between the two observers. 95% versus 100% were at least acceptable reproducible landmarks. This study allows us to understand the way bipartition distraction corrects the abnormalities of the Apert skull. Analysing the surgical outcome of facial bipartition with geometric morphometrics shows that some major Apert characteristics are corrected. Using the data and the output of further studies, surgical procedures can be adapted in order to achieve a postoperative result closer to the normal population. LEVEL OF EVIDENCE Therapeutic clinical question Level IV.
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Affiliation(s)
| | | | - Dariush Nikkhah
- Great Ormond Street Hospital, London, United Kingdom; Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Clifford Ruff
- Medical Physics Department, University College London, London, United Kingdom
| | - David Dunaway
- Great Ormond Street Hospital, London, United Kingdom
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Planning Surgical Reconstruction in Treacher-Collins Syndrome Using Virtual Simulation. Plast Reconstr Surg 2013; 132:790e-805e. [DOI: 10.1097/prs.0b013e3182a48d33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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