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Lin Y, Ma X, Huang Y, Mu L, Yang L, Zhao M, Xie F, Zhang C, Xu J, Lu J, Teng L. Craniofacial and Upper Airway Development in Patients With Treacher Collins Syndrome. J Craniofac Surg 2021; 32:2305-2309. [PMID: 34705378 DOI: 10.1097/scs.0000000000007661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study evaluated age-associated morphology changes in the cranial base, facial development, and upper airway of patients with Treacher Collins syndrome (TCS). A total of 33 preoperative computed tomographic images (TCS, n = 14; control, n = 19) were included in the study and divided into three age-related subgroups (2-6 years, 7-18 years, and older than 18 years). Linear, angular cephalometric measurements and upper airway volumes were collected. All measurements were analyzed using ProPlan CMF software (version 3.0; Materialize, Leuven, Belgium). The association between aging and upper airway morphology was analyzed. Compared to control subjects, TCS patients had a smaller cranial base, maxilla, and nose; they also had reduced upper airway volume compared to control subjects. The observed differences were most significant in patients between the ages of 7 and 18 years. This study used computed tomography-based three-dimensional analyses to provide a detailed description of age-related changes that occur in craniofacial measurements and upper airway volumes in children, adolescents, and young adult patients with TCS in China. These data can be used to evaluate individual patients with TCS and to select treatment to improve the growth of the craniofacial region.
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Affiliation(s)
- Yanxian Lin
- Department of Craniofacial Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Katsube M, Yamada S, Yamaguchi Y, Takakuwa T, Yamamoto A, Imai H, Saito A, Shimizu A, Suzuki S. Critical Growth Processes for the Midfacial Morphogenesis in the Early Prenatal Period. Cleft Palate Craniofac J 2019; 56:1026-1037. [PMID: 30773047 DOI: 10.1177/1055665619827189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Congenital midfacial hypoplasia often requires intensive treatments and is a typical condition for the Binder phenotype and syndromic craniosynostosis. The growth trait of the midfacial skeleton during the early fetal period has been assumed to be critical for such an anomaly. However, previous embryological studies using 2-dimensional analyses and specimens during the late fetal period have not been sufficient to reveal it. OBJECTIVE To understand the morphogenesis of the midfacial skeleton in the early fetal period via 3-dimensional quantification of the growth trait and investigation of the developmental association between the growth centers and midface. METHODS Magnetic resonance images were obtained from 60 human fetuses during the early fetal period. Three-dimensional shape changes in the craniofacial skeleton along growth were quantified and visualized using geometric morphometrics. Subsequently, the degree of development was computed. Furthermore, the developmental association between the growth centers and the midfacial skeleton was statistically investigated and visualized. RESULTS The zygoma expanded drastically in the anterolateral dimension, and the lateral part of the maxilla developed forward until approximately 13 weeks of gestation. The growth centers such as the nasal septum and anterior portion of the sphenoid were highly associated with the forward growth of the midfacial skeleton (RV = 0.589; P < .001). CONCLUSIONS The development of the midface, especially of the zygoma, before 13 weeks of gestation played an essential role in the midfacial development. Moreover, the growth centers had a strong association with midfacial forward growth before birth.
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Affiliation(s)
- Motoki Katsube
- 1 Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,2 Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigehito Yamada
- 2 Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,3 Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yutaka Yamaguchi
- 2 Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tetsuya Takakuwa
- 3 Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Yamamoto
- 4 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirohiko Imai
- 5 Department of Systems Science, Kyoto University Graduate School of Informatics, Kyoto, Japan
| | - Atsushi Saito
- 6 Institute of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akinobu Shimizu
- 6 Institute of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Shigehiko Suzuki
- 1 Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Levasseur J, Nysjö J, Sandy R, Britto JA, Garcelon N, Haber S, Picard A, Corre P, Odri GA, Khonsari RH. Orbital volume and shape in Treacher Collins syndrome. J Craniomaxillofac Surg 2018; 46:305-311. [DOI: 10.1016/j.jcms.2017.11.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/01/2017] [Accepted: 11/30/2017] [Indexed: 01/22/2023] Open
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Dornelles RDFV, Alonso N. New virtual tool for accurate evaluation of facial volume. Acta Cir Bras 2017; 32:1075-1086. [DOI: 10.1590/s0102-865020170120000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/16/2017] [Indexed: 11/22/2022] Open
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Cephalometric Predictors of Clinical Severity in Treacher Collins Syndrome. Plast Reconstr Surg 2017; 140:1240-1249. [DOI: 10.1097/prs.0000000000003853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lewyllie A, Cadenas De Llano-Pérula M, Verdonck A, Willems G. Three-dimensional imaging of soft and hard facial tissues in patients with craniofacial syndromes: a systematic review of methodological quality. Dentomaxillofac Radiol 2017; 47:20170154. [PMID: 29168926 DOI: 10.1259/dmfr.20170154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To systematically review the methodological quality of three-dimensional imaging studies of patients with craniofacial syndromes and to propose recommendations for future research. METHODS PubMed, Embase and Cochrane databases as well as Grey literature were electronically searched. Inclusion criteria were patients with genetic syndromes with craniofacial manifestations and three-dimensional imaging of facial soft and/or hard tissues. Exclusion criteria consisted of non-syndromic conditions or conditions owing to environmental causes, injury or trauma, facial soft and hard tissues not included in the image analysis, case reports, reviews, opinion articles. No restrictions were made for patients' ethnicity nor age, publication language or publication date. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS The search yielded 2228 citations of which 116 were assessed in detail and 60 were eventually included in this review. Studies showed a large heterogeneity in study design, sample size and patient age. An increase was observed in the amount of studies with time, and the imaging method most often used was CT. The most studied craniofacial syndromes were Treacher Collins, Crouzon and Apert syndrome. The articles could be divided into three main groups: diagnostic studies (34/60, 57%), evaluation of surgical outcomes (21/60, 35%) and evaluation of imaging techniques (5/60, 8%). For comparative studies, the median MINORS score was 13 (12-15, 25-75th percentile), and for non-comparative studies, the median MINORS score was 8 (7-9, 25-75th percentile). CONCLUSIONS The median MINORS scores were only 50 and 54% of the maximum scores and there was a lack of prospective, controlled trials with sufficiently large study groups. To improve the quality of future studies in this domain and given the low incidence of craniofacial syndromes, more prospective multicentre controlled trials should be set up.
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Affiliation(s)
- Arianne Lewyllie
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Maria Cadenas De Llano-Pérula
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Guy Willems
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
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Katsube M, Yamada S, Miyazaki R, Yamaguchi Y, Makishima H, Takakuwa T, Yamamoto A, Fujii Y, Morimoto N, Ito T, Imai H, Suzuki S. Quantitation of nasal development in the early prenatal period using geometric morphometrics and MRI: a new insight into the critical period of Binder phenotype. Prenat Diagn 2017; 37:907-915. [PMID: 28675493 DOI: 10.1002/pd.5106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/02/2017] [Accepted: 06/29/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Disturbance of the development of the nasal septum in the early prenatal period causes congenital facial anomalies characterized by a flat nose and defects of the anterior nasal spine (ANS), such as Binder phenotype. The present research aimed to assess the development of the nasal septum and the ANS with growth in the early prenatal period. METHODS Magnetic resonance images were obtained from 56 specimens. Mid-sagittal images were analyzed by using geometric morphometrics for the development of the nasal septum, and angle analysis was performed for the development of the ANS. Additionally, we calculated and visualized the ontogenetic allometry of the nasal septum. RESULTS Our results showed that the nasal septum changed shape in the anteroposterior direction in smaller specimens, while it maintained an almost isometric shape in larger specimens. Furthermore, mathematical evidence revealed that the maturation periods of the shapes of the ANS and the nasal septum were around 12 and 14 weeks of gestation, respectively. CONCLUSION The anteroposterior development of the nasal septum is specific until 14 weeks of gestation, and it is important for nasal protrusion and the development of the ANS. Therefore, the disturbance of such development could induce low nasal deformity, including Binder phenotype. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Motoki Katsube
- Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Reina Miyazaki
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yutaka Yamaguchi
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruyuki Makishima
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tetsuya Takakuwa
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Fujii
- Statistical Genetics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoki Morimoto
- Department of Zoology, Kyoto University Graduate School of Science, Kyoto, Japan
| | - Tsuyoshi Ito
- Primate Research Institute, Kyoto University, Aichi, Japan.,The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Hirohiko Imai
- Department of Systems Science, Kyoto University Graduate School of Informatics, Kyoto, Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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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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Ibrahim A, Suttie M, Bulstrode NW, Britto JA, Dunaway D, Hammond P, Ferretti P. Combined soft and skeletal tissue modelling of normal and dysmorphic midface postnatal development. J Craniomaxillofac Surg 2016; 44:1777-1785. [PMID: 27720275 DOI: 10.1016/j.jcms.2016.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/02/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Midface hypoplasia as exemplified by Treacher Collins Syndrome (TCS) can impair appearance and function. Reconstruction involves multiple invasive surgeries with variable long-term outcomes. This study aims to describe normal and dysmorphic midface postnatal development through combined modelling of skeletal and soft tissues and to develop a surgical evaluation tool. MATERIALS AND METHODS Midface skeletal and soft tissue surfaces were extracted from computed tomography scans of 52 control and 14 TCS children, then analysed using dense surface modelling. The model was used to describe midface growth, morphology, and asymmetry, then evaluate postoperative outcomes. RESULTS Parameters responsible for the greatest variation in midface size and shape showed differences between TCS and controls with close alignment between skeletal and soft tissue models. TCS children exhibited midface dysmorphology and hypoplasia when compared with controls. Asymmetry was also significantly higher in TCS midfaces. Combined modelling was used to evaluate the impact of surgery in one TCS individual who showed normalisation immediately after surgery but reversion towards TCS dysmorphology after 1 year. CONCLUSION This is the first quantitative analysis of postnatal midface development using combined modelling of skeletal and soft tissues. We also provide an approach for evaluation of surgical outcomes, laying the foundations for future development of a preoperative planning tool.
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Affiliation(s)
- Amel Ibrahim
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Michael Suttie
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Neil W Bulstrode
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Jonathan A Britto
- Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - David Dunaway
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom
| | - Peter Hammond
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom; Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford OX3 7DQ, United Kingdom.
| | - Patrizia Ferretti
- UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom.
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Treacher Collins Syndrome: A Systematic Review of Evidence-Based Treatment and Recommendations. Plast Reconstr Surg 2016; 137:191-204. [PMID: 26710023 DOI: 10.1097/prs.0000000000001896] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No reviews or guidelines are available on evidence-based treatment for the multidisciplinary approach in Treacher Collins syndrome. The authors' aim is to provide an evidence-based review of multidisciplinary treatment of Treacher Collins syndrome based on levels of evidence and supported with graded recommendations. METHODS A systematic search was performed by means of the PubMed, Web-of-Science, Embase, and Cochrane Central databases (1985 to January of 2014). Included were clinical studies (with five or more Treacher Collins syndrome patients) related to therapy, diagnosis, or risk of concomitant diseases. Level of evidence of the selected articles was rated according to the American Society of Plastic Surgeons evidence-based clinical practice guidelines. After two panelists had reviewed each abstract separately, a consensus method was used to solve any disagreements concerning article inclusion. RESULTS Of the 2433 identified articles, 63 studies (Level of Evidence II through V) were included. Conclusions and recommendations were extracted consecutively for the following items: upper airway; ear, hearing, and speech; the eye, eyelashes, and lacrimal system; growth, feeding, and swallowing; the nose; psychosocial factors; and craniofacial reconstruction. CONCLUSIONS In this systematic review, current evidence for the multidisciplinary treatment of Treacher Collins syndrome is provided, recommendations for treatment are made, and a proposed algorithm for treatment is presented. Although some topics are well supported, others, especially ocular, nasal, speech, feeding, and swallowing problems, lack sufficient evidence. In addition, craniofacial surgical reconstruction lacks a sufficient level of evidence to provide a sound basis for a full treatment protocol. Despite the rarity of the syndrome, more research is needed to compare outcomes of several surgical treatments, especially in orbitozygomatic/maxillary regions.
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Long-term orthognathic surgical outcomes in Treacher Collins patients. J Plast Reconstr Aesthet Surg 2016; 69:402-8. [DOI: 10.1016/j.bjps.2015.10.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/02/2015] [Accepted: 10/21/2015] [Indexed: 11/23/2022]
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Abstract
The complex three-dimensional anatomy of the craniofacial skeleton creates a formidable challenge for surgical reconstruction. Advances in computer-aided design and computer-aided manufacturing technology have created increasing applications for virtual surgical planning in craniofacial surgery, such as preoperative planning, fabrication of cutting guides, and stereolithographic models and fabrication of custom implants. In this review, the authors describe current and evolving uses of virtual surgical planning in craniofacial surgery.
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Affiliation(s)
- Harvey Chim
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Wetjen
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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Treacher Collins Syndrome: the genetics of a craniofacial disease. Int J Pediatr Otorhinolaryngol 2014; 78:893-8. [PMID: 24690222 DOI: 10.1016/j.ijporl.2014.03.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The molecular underpinnings of Treacher Collins Syndrome (TCS) are diverse. This article codifies the most recent findings in this complex area of research to further current understanding of the disease process. Elucidating the genetic causes of the disorder can be useful in earlier detection and better treatment planning. DESIGN Articles from 1991 to 2013 were selected and reviewed by five researchers utilizing the most recent literature of the genetics and pathophysiology of TCS. RESULTS Mutations in TCOF1, POLR1C and POLR1D have all been implicated in causing TCS. The association of the TCOF1 gene product, Treacle, and gene products of POLR1C and POLR1D with ribosome biosynthesis suggests that a loss of function mutation in these genes disrupts ribosome biosynthesis in constituent neural crest cells and neuroepithelium leading to apoptosis. However, recent data illustrating that P53 heterozygosity is protective against TCS, and that P53 and TCOF1 hemizygous embryos do not affect ribosomal function, implicates P53 or elements downstream of P53 as playing a role in TCS pathogenesis. CONCLUSION Our study codified nascent findings of the molecular determinants of TCS. These findings add to a burgeoning database of TCS-associated mutations, and as such, can be used to establish TCS diagnosis and further clarify TCS pathogenesis.
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