Amel Ibrahim1, Michael Suttie2, Neil W Bulstrode1, Jonathan A Britto3, David Dunaway1, Peter Hammond4, Patrizia Ferretti5. 1. 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. 2. 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. 3. Department of Plastic Surgery, Great Ormond Street Hospital NHS Trust, London WC1N 3JH, United Kingdom. 4. 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. Electronic address: peter.hammond@obs-gyn.ox.ac.uk. 5. UCL Great Ormond Street Institute of Child Health (Head: Prof. R. Smyth), University College London, London WC1N 1EH, United Kingdom. Electronic address: p.ferretti@ucl.ac.uk.
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.
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 TCSchildren, 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. TCSchildren 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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