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BackgroundMidface 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 methodsMidface 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.ResultsParameters 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.ConclusionThis 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.

Original publication




Journal article


Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

Publication Date





1777 - 1785


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.


Face, Facial Bones, Humans, Mandibulofacial Dysostosis, Tomography, X-Ray Computed, Imaging, Three-Dimensional, Cephalometry, Reconstructive Surgical Procedures, Case-Control Studies, Retrospective Studies, Maxillofacial Development, Image Processing, Computer-Assisted, Child, Child, Preschool, Infant, Female, Male