Variations in the correction of Treacher Collins syndrome.

A new combination of basically known techniques is described for the correction of Treacher Collins syndrome. The patients are treated in two to three operative sessions beginning early in the second decade of life. The main components are a chin advancement simultaneously with malar osteotomies in a first operation. In the second operation, the chin prominence is moved further forward by a simultaneous vertical movement of the maxilla, sagittal split osteotomy and body osteotomy of the mandible, together with a further chin advancement. Additional finishing touches may ask for a third intervention. Since there is a large variability of expression of the different signs, the techniques have to allow for a good deal of flexibility. The study of 10 patients reflects the considerable variations in the condition at the outset and the adequacy of the basic treatment protocol. The results of malar osteotomies are better than those of pure onlay augmentation. Despite the complexity of the maxillomandibular osteotomies, occlusal results are reasonably stable, and aesthetic improvement is considerable. The adaptation of the treatment to the individual patient resulted in modifications of direction of movement for different segments but also in omission of parts of the standard osteotomies. As a consequence, a modified treatment plan will be used as often as the standard program. The causes for the two not satisfying results are explained, and they demonstrate the limitations of the concept.