Fan Kenneth L, Federico Christina, Kawamoto Henry K, Bradley James P
Division of Plastic Surgery, David Geffen School of Medicine, University Of California-Los Angeles, 200 UCLA Medical Plaza, Los Angeles, CA 90095, USA.
J Craniofac Surg. 2012 Nov;23(7 Suppl 1):2033-7. doi: 10.1097/SCS.0b013e318262d7fb.
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. To study the optimal age for reconstruction clinically, we examined 3 age groups based on timing of malar and eyelid reconstruction using a three-dimensional computed tomographic scan and three-dimensional photometric volume assessment. In addition, we collected outcome assessments from parents/patients using satisfaction surveys. Of 73 patients with Treacher Collins at the University of California Los Angeles Craniofacial Clinic, 45 had malar reconstruction, complete records, and were available for study. The patients were separated into 3 groups: (1) very young = 0 to 5 years, (2) mid-childhood = 6 to 12 years, and (3) adolescent/adult 13 years and older. As hypothesized, the 0 to 5 age group experienced the greatest percentage of complete bony resorption (77%) compared with the 6 to 12 age group (only 4%) and the 13 and older age group (0%). Interestingly, the 0 to 5 age group experienced the highest parent/patient satisfaction, possibly owing to better psychosocial experience. When dealing with treatment plans for patients with Treacher Collins, patients, parents, and physicians must balance the benefits of early surgical intervention, such as improved psychologic well-being, with the disadvantages of having to undergo a greater number of procedures, such as fat grafting after malar bone graft resorption.
关于颧骨眶部骨重建，Treacher Collins综合征的最佳时机和治疗方法尚未完全确立。早期进行骨重建可能会导致骨移植吸收；然而，手术改善的延迟可能会对患者产生不良的心理社会影响。为了临床研究重建的最佳年龄，我们使用三维计算机断层扫描和三维光度体积评估，根据颧骨和眼睑重建的时间检查了3个年龄组。此外，我们通过满意度调查收集了父母/患者的结果评估。在加利福尼亚大学洛杉矶分校颅面诊所的73例Treacher Collins综合征患者中，45例进行了颧骨重建，有完整记录且可供研究。患者被分为3组：(1) 非常年幼组 = 0至5岁，(2) 童年中期组 = 6至12岁，(3) 青少年/成人组 = 13岁及以上。正如所假设的，与6至12岁年龄组（仅4%）和13岁及以上年龄组（0%）相比，0至5岁年龄组完全骨吸收的比例最高（77%）。有趣的是，0至5岁年龄组的父母/患者满意度最高，这可能是由于更好的心理社会体验。在处理Treacher Collins综合征患者的治疗方案时，患者、父母和医生必须权衡早期手术干预的益处，如改善心理健康，与不得不接受更多手术的缺点，如颧骨骨移植吸收后的脂肪移植。
