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Van Roey VL, Irvine WF. Optimal Diagnostic and Treatment Practices for Facial Dysostosis Syndromes: A Clinical Consensus Statement Among European Experts. J Craniofac Surg 2024; 35:00001665-990000000-01634. [PMID: 38801252 PMCID: PMC11198962 DOI: 10.1097/scs.0000000000010280] [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: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
Facial dysostosis syndromes (FDS) are rare congenital conditions impacting facial development, often leading to diverse craniofacial abnormalities. This study addresses the scarcity of evidence on these syndromes about optimal diagnostic and treatment practices. To overcome this scarcity, European experts from ERN CRANIO collaborated to develop a clinical consensus statement through the Delphi consensus method. A systematic search of Embase, MEDLINE/PubMed, Cochrane, and Web of Science databases was conducted until February 2023. The quality of evidence was evaluated using various tools depending on the study design. Statements were subsequently formed based on literature and expert opinion, followed by a Delphi process with expert health care providers and patient representatives. In total, 92 experts from various specialties and three patient representatives were involved in the Delphi process. Over 3 voting rounds, consensus was achieved on 92 (46.9%), 58 (59.2%), and 19 (70.4%) statements, respectively. These statements cover the topics of general care; craniofacial reconstruction; the eyes and lacrimal system; upper airway management; genetics; hearing; speech; growth, feeding, and swallowing; dental treatment and orthodontics; extracranial anomalies; and psychology and cognition. The current clinical consensus statement provides valuable insights into optimal diagnostic and treatment practices and identifies key research opportunities for FDS. This consensus statement represents a significant advancement in FDS care, underlining the commitment of health care professionals to improve the understanding and management of these rare syndromes in Europe.
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Affiliation(s)
- Victor L. Van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders, Rotterdam, The Netherlands
| | - Willemijn F.E. Irvine
- Department of Pediatric Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Evidence-Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
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Yin B, Shi B, Jia ZL. [Pathogenic genes and clinical therapeutic strategies for Treacher Collins syndrome]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:330-335. [PMID: 31218872 DOI: 10.7518/hxkq.2019.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Treacher Collins syndrome is a congenital craniofacial malformation with autosomal dominant inheritance as the main genetic pattern. In this condition, the biosynthesis of ribosomes in neural crest cells and neuroepithelial cells is blocked and the number of neural crest cells that migrate to the craniofacial region decreases, causing first and second branchial arch dysplasia. Definite causative genes include treacle ribosome biogenesis factor 1 (tcof1), RNA polymerase Ⅰ and Ⅲ subunit C (polr1c), and RNA polymerase Ⅰ and Ⅲ subunit D (polr1d). This paper provides a review of research of three major patho-genic genes, pathogenesis, phenotypic research, prevention, and treatment of the syndrome.
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Affiliation(s)
- Bin Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhong-Lin Jia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Galea CJ, Dashow JE, Woerner JE. Congenital Abnormalities of the Temporomandibular Joint. Oral Maxillofac Surg Clin North Am 2018; 30:71-82. [DOI: 10.1016/j.coms.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Plomp RG, Versnel SL, van Lieshout MJS, Poublon RML, Mathijssen IMJ. Long-term assessment of facial features and functions needing more attention in treatment of Treacher Collins syndrome. J Plast Reconstr Aesthet Surg 2013; 66:e217-26. [PMID: 23615184 DOI: 10.1016/j.bjps.2013.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/19/2013] [Accepted: 03/16/2013] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine which facial features and functions need more attention during surgical treatment of Treacher Collins syndrome (TCS) in the long term. METHOD A cross-sectional cohort study was conducted to compare 23 TCS patients with 206 controls (all≥18 years) regarding satisfaction with their face. The adjusted Body Cathexis Scale was used to determine satisfaction with the appearance of the different facial features and functions. Desire for further treatment of these items was questioned. For each patient an overview was made of all facial operations performed, the affected facial features and the objective severity of the facial deformities. RESULTS Patients were least satisfied with the appearance of the ears, facial profile and eyelids and with the functions hearing and nasal patency (P<0.001). Residual deformity of the reconstructed facial areas remained a problem in mainly the orbital area. The desire for further treatment and dissatisfaction was high in the operated patients, predominantly for eyelid reconstructions. Another significant wish was for improvement of hearing. CONCLUSION In patients with TCS, functional deficits of the face are shown to be as important as the facial appearance. Particularly nasal patency and hearing are frequently impaired and require routine screening and treatment from intake onwards. Furthermore, correction of ear deformities and midface hypoplasia should be offered and performed more frequently. Residual deformity and dissatisfaction remains a problem, especially in reconstructed eyelids. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Raul G Plomp
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Swibel Rosenthal LH, Caballero N, Drake AF. Otolaryngologic manifestations of craniofacial syndromes. Otolaryngol Clin North Am 2012; 45:557-77, vii. [PMID: 22588037 DOI: 10.1016/j.otc.2012.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review describes important aspects of the most commonly encountered craniofacial syndromes. The goal is to provide otolaryngologists and other health care providers with critical information necessary to manage these patients appropriately. The algorithm provided in this article should be helpful in guiding the treatment of craniofacial patients based on their unique otolaryngologic characteristics. The principles highlighted in the algorithm can be applied to other craniofacial syndromes not addressed here, including Pierre Robin sequence and Down syndrome.
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Affiliation(s)
- Laura H Swibel Rosenthal
- Division of Neurosciences, Department of Otolaryngology - Head and Neck Surgery, Stritch School of Medicine, Loyola University Hospital, 2160 South First Avenue, Maywood, IL 60153-5500, USA.
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Thomeer HGXM, Kunst HPM, Cremers WRJ. Congenital Ossicular Chain Anomalies Associated with a Mobile Stapes Footplate: Surgical Results for 23 Ears. Ann Otol Rhinol Laryngol 2012; 121:275-81. [DOI: 10.1177/000348941212100414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: We describe the audiometric results following surgery in a consecutive series of patients with a congenital ossicular middle ear disorder that was associated with a mobile stapes footplate. Methods: We performed a retrospective analysis of patient charts from a tertiary referral center. A total of 23 patients (23 ears) underwent exploratory tympanotomy and ossicular reconstruction between 1986 and 2001. The main outcome measure was the audiometric results. Results: Overall, we observed a mean gain in air conduction pure tone average of 17 dB (from 47 dB to 30 dB), a sensorineural deterioration of 3 dB, and a mean postoperative air-bone gap of 19 dB (mean preoperative air-bone gap of 38 dB). The air-bone gap closure was 20 dB or less in 15 of the 23 cases (65%), in agreement with the few results reported in the literature. Moreover, the audiometric results remained stable. In the syndromic group, the mean gain in air conduction was only 13 dB, which was worse than that observed for the nonsyndromic ears. Conclusions: Surgery for congenital ossicular chain anomalies with a concomitant mobile stapes footplate provides positive audiometric outcomes. Most ears had some sensorineural impairment (10 to 20 dB), which influenced the final hearing level attained after surgery. Preoperative assessment is mandatory to search for syndromal diagnoses, which might be important for patient counseling and prognosis.
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Abstract
Treacher Collins syndrome (TCS) is a rare autosomal dominant disorder of craniofacial development. It is a congenital malformation of first and second branchial arch which may affect the size and shape of the ears, eyelids, cheek bones, and jaws. The extent of facial deformity varies from one affected individual to another. A case of 20-year-old boy having TCS is briefly described in this article.
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Affiliation(s)
- Prachi Shete
- Departments of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, India
| | - JV Tupkari
- Department of Oral Pathology, Government Dental College and Hospital, Mumbai, India
| | - Tabita Benjamin
- Department of Oral Pathology, Government Dental College and Hospital, Mumbai, India
| | - Aarti Singh
- Departments of Oral Medicine and Radiology, Government Dental College and Hospital, Mumbai, India
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Noble W, Tyler R, Dunn C, Bhullar N. Unilateral and bilateral cochlear implants and the implant-plus-hearing-aid profile: comparing self-assessed and measured abilities. Int J Audiol 2008; 47:505-14. [PMID: 18608531 DOI: 10.1080/14992020802070770] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients fitted with one (CI) versus two (CI+CI) cochlear implants, and those fitted with one implant who retain a hearing aid in the non-implanted ear (CI+HA), were compared using the speech, spatial, and qualities of hearing scale (SSQ) (Gatehouse & Noble, 2004). The CI+CI profile yielded significantly higher ability ratings than the CI profile in the spatial hearing domain, and on most aspects of other qualities of hearing (segregation, naturalness, and listening effort). A subset of patients completed the SSQ prior to implantation, and the CI+CI profile showed consistently greater improvement than the CI profile across all domains. Patients in the CI+HA group self-rated no differently from the CI group, post-implant. Measured speech perception and localization performance showed some parallels with the self-rating outcomes. Overall, a unilateral CI provided significant benefit across most hearing functions reflected in the SSQ. Bilateral implantation offered further benefit across a substantial range of those functions.
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Posnick JC, Tiwana PS, Costello BJ. Treacher Collins syndrome: comprehensive evaluation and treatment. Oral Maxillofac Surg Clin North Am 2004; 16:503-23. [DOI: 10.1016/j.coms.2004.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kaga K, Takegoshi H, Yamasoba T, Nakamura M, Kaneko M, Ino K. Aplasia of zygomatic arch and dislocation of temporomandibular joint capsule in Treacher-Collins syndrome: three-dimensional reconstruction of computed tomographic scans. Int J Pediatr Otorhinolaryngol 2003; 67:1189-94. [PMID: 14597369 DOI: 10.1016/j.ijporl.2003.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seven patients with Treacher-Collins syndrome were studied. All of patients were children or teenagers. Helical CT scanner (Toshiba) was used to reconstruct zygomatic arch and temporomandibular joint capsule on lateral aspect of temporal bone in five patients of microtia and atresia of both ears and two patients of narrow ear canals of both ears without microtia.Three-dimensional reconstructions of computed tomography on lateral aspect of temporal bone demonstrated various congenital abnormality including aplasia of zygomatic arch in seven patients and dislocation of temporomandibular joint capsule in seven patients.
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Affiliation(s)
- Kimitaka Kaga
- Department of Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Bresnick S, Walker J, Clarke-Sheehan N, Reinisch J. Increased Fistula Risk Following Palatoplasty in Treacher Collins Syndrome. Cleft Palate Craniofac J 2003. [DOI: 10.1597/1545-1569(2003)040<0280:ifrfpi>2.0.co;2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Abstract
OBJECTIVE Treacher Collins syndrome (TCS) is an inherited disorder in which there are general bilateral symmetric anomalies of the structures within the first and second branchial arches. In general, there is complete penetrance and variable expressivity of the trait. The craniofacial rehabilitation of a child with TCS is tailored to the extent of the deformities involved: the orbitozygomatic region, the maxillomandibular region, the nose, facial soft tissues, and external and middle ear structures. CONCLUSION This article reviews the range of clinical features and specific dysmorphology observed in TCS. Functional and aesthetic objectives are discussed, and a comprehensive staged reconstructive approach is outlined, which may be used as a roadmap for treatment planning.
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Affiliation(s)
- J C Posnick
- Posnick Center for Facial Plastic Surgery, Chevy Chase, Maryland 20815, USA.
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Posnick JC, Ruiz RL. Treacher Collins Syndrome: Current Evaluation, Treatment, and Future Directions. Cleft Palate Craniofac J 2000. [DOI: 10.1597/1545-1569_2000_037_0434_tcscet_2.0.co_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective Treacher Collins syndrome (TCS) is an inherited disorder in which there are bilateral symmetric anomalies of the structures within the first and second branchial arches. In general, there is complete penetrance and variable expressivity of the trait. The craniofacial rehabilitation of a child with TCS is tailored to the extent of the deformities involved: the orbitozygomatic region, the maxillomandibular region, the nose, facial soft tissues, and external and middle ear structures. Conclusion This article reviews the range of clinical features and specific dysmorphology observed in TCS. Functional and aesthetic objectives are discussed, and a comprehensive staged reconstructive approach is outlined, which may be used as a roadmap for treatment planning.
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Affiliation(s)
- Jeffrey C. Posnick
- Posnick Center for Facial Plastic Surgery and Department of (Plastic) Surgery, Pediatrics, Otolaryngology/Head and Neck Surgery, and Oral and Maxillofacial Surgery, Georgetown University, Washington, D.C
| | - Ramon L. Ruiz
- Pediatric Craniofacial Surgery, Posnick Center for Facial Plastic Surgery, Chevy Case, Maryland, and Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Affiliation(s)
- J C Posnick
- Division of Plastic Surgery, Georgetown University Medical Center, Washington, DC 20007-2197, USA
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