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OPTIMIZING THE TIMING AND TECHNIQUE OF TREACHER COLLINS ORBITAL MALAR RECONSTRUCTION
Presenter: Christina Federico, BA
Co-Authors: Lee JC; Fan KL; Kawamoto HK; Bradley JP
UCLA

Background: The optimal timing and treatment of Treacher Collins syndrome with regard to zygomatico-orbital osseous reconstruction has not been fully established. Osseous reconstruction performed at an early age may result in bone graft resorption; however, delays in surgical improvement may result in adverse psychosocial effects on the patient. In this study, we attempted to establish the optimal age at which a patient with Treacher Collins should undergo orbital/malar reconstruction based on bone resorption rate. We also surveyed the satisfaction of the patient/parents after the procedure.

Methods: To study the optimal age for reconstruction clinically, we examined three age groups based on timing of malar and eyelid reconstruction using a 3D CT scan and 3D photometric volume assessment. In addition, we collected outcome assessments from parents/patients using satisfaction surveys. Of 73 Treacher Collins patients at the UCLA Craniofacial Clinic, 45 had malar reconstruction, complete records, and were available for study. The patients were separated into three groups: 1) Very young = 0-5 years 2) Mid-childhood = 6-12 years, and 3) Adolescent/adult ?13 years.

Results: As predicted, the 0-5 age group experienced the greatest percentage of complete bony resorption (77%) compared to the 6-12 age group (only 4%) and the 13 and older age group (0%). Other complications (wound infection, vision problems, excessive scarring reoperations) were low and similar in all three groups. Interestingly, the 0-5 age group experienced the highest parent/patient satisfaction, possibly due to better psychosocial experience.

Conclusion: When planning treatment for patients with Treacher Collins, patients, parents, and physicians must balance the benefits of early surgical intervention (such as improved psychological well being) with the disadvantages of having to undergo a greater number of procedures (such as fat grafting after malar bone graft resorption).


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