Combined soft and skeletal tissue modelling of normal and dysmorphic midface postnatal development

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.

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“…Eight pairs of anatomical points (i.e., points from the physical head and its correspondence on the rendered scanned volume) must be provided manually. In this study, we used the inion, right outer corner of eye, nasion, preauricular left, preauricular right, glabella, left alar, and right alar as the anatomical references (Sforza and Ferrario, 2006;Ibrahim et al, 2016). The singular value decomposition (SVD) technique was applied to find the elements of the transformation matrix.…”

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