Treacher Collins Sydrome: Treatment

The cheekbones are usually 80-90% of their adult size by the time a child reaches 9-years old. Therefore, it is wise to wait until at least this old before trying to reconstruct this area. I prefer to rebuild the missing bone, with the child's own bone. The bone to rebuild this area is usually taken from the skull for two different reasons. The first is that bone taken from the skull is less likely to disappear after the operation (bone taken from the rib, or hip, is more likely to dissolve away). The second reason is that there is almost no pain associated with taking bone from the skull. Is taking bone from the skull safe? In Dallas, we have been fortunate to have not had any complications from this technique. The safety of this technique, when performed at our center, has been published (see publications [ #16]), but it is certainly possible for a patient in the future to have a problem. In addition to rebuilding the absent cheekbones, often children will undergo a transfer of underlying soft tissue to the cheeks, a reshaping of the nose, and a lifting of the corners of the eyes, all in the same operation.

When the face has finished growing (around age 17), and all necessary jaw surgery has been completed, then it is safe to place artificial cheekbones to complete the reconstruction. This gives the child their final, normal-looking, adult sized cheekbones. It is very important that these implants not be placed too young, while the child is still growing, because they will sink too deeply into the underlying bone. More importantly, if any upper jaw surgery is performed after the cheek implants are placed, they will have to be removed in order to prevent a serious infection.