{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:37:03Z","timestamp":1786649823193,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Reconstruction of zygomatic agenesis in Treacher-Collins syndrome (TCS) poses a significant challenge. Traditional bone grafting techniques often fail to address the complex three-dimensional (3D) anatomy and biomechanical demands. This study introduces an approach using kerfed rib grafts and titanium scaffolding for such reconstructions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective review was conducted on six TCS patients (five males, one female; mean age 20.17 \u00b1 2.91 years) with zygomatic agenesis. Pre-operative 3D computed tomography imaging guided surgical planning. Kerfed rib grafts, harvested via a subperiosteal approach, were meticulously contoured and secured to the maxilla and zygomatic root using pre-contoured titanium plates through bicoronal and intraoral incisions. Lateral canthal ligaments were repositioned and hypoplastic maxillae augmented with recombinant human bone morphogenetic protein-2 (rhBMP2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All six patients underwent successful single-stage reconstruction without intraoperative or post-operative complications, including infection or donor-site morbidity. Over a 12-month follow-up, stable reconstructions with significant improvements in facial symmetry and function were observed. Radiographic assessments confirmed adequate integration of rib grafts and maintained structural stability; no revision surgeries were required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Kerfed rib grafts, combined with titanium scaffolding, offer superior conformability, reduced donor-site morbidity and improved aesthetic outcomes compared to traditional techniques for severe zygomatic hypoplasia in TCS. This approach addresses the limitations of calvarial and non-kerfed rib grafts by providing enhanced flexibility, stress distribution and vascularisation. Long-term studies are needed to evaluate the durability of these reconstructions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ams.ams_28_25","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T19:00:17Z","timestamp":1752087617000},"page":"72-77","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Reconstruction of Zygoma in Total Agenesis in Treacher-Collins Syndrome Using Kerfed Rib Grafts - A Retrospective Study"],"prefix":"10.4103","volume":"15","author":[{"given":"S. M.","family":"Balaji","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preetha","family":"Balaji","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"R1-20250710","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1097\/SCS.0000000000002065","article-title":"Rib bone graft adjusted to fit the facial asymmetry: A frame structure graft","volume":"26","author":"Lee","year":"2015","journal-title":"J Craniofac Surg"},{"key":"R2-20250710","doi-asserted-by":"crossref","first-page":"38S","DOI":"10.1097\/01.prs.0000173906.35257.e0","article-title":"Taking long rib grafts for facial reconstruction \u2013Tools and techniques: III. A, 2900-case experience in maxillofacial and craniofacial surgery","volume":"116","author":"Tessier","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"R3-20250710","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5125\/jkaoms.2018.44.4.151","article-title":"Zygomaticomaxillary buttress and its dilemma","volume":"44","author":"Malaviya","year":"2018","journal-title":"J Korean Assoc Oral Maxillofac Surg"},{"key":"R4-20250710","doi-asserted-by":"crossref","first-page":"e241351","DOI":"10.1136\/bcr-2020-241351","article-title":"Long-term treatment outcomes from a patient's perspective with Treacher Collins syndrome","volume":"14","author":"Smith","year":"2021","journal-title":"BMJ Case Rep"},{"key":"R5-20250710","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1001\/archotol.131.2.131","article-title":"Midfacial reconstruction using calvarial split bone grafts","volume":"131","author":"Smolka","year":"2005","journal-title":"Arch Otolaryngol Head Neck 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reconstruction of extensive maxillomandibular defects in adults","volume":"93","author":"K\u00e4mmerer","year":"2023","journal-title":"Periodontol 2000"},{"key":"R13-20250710","doi-asserted-by":"crossref","first-page":"882631","DOI":"10.3389\/fbioe.2022.882631","article-title":"Biomechanical effects of 3D-printed bioceramic scaffolds with porous gradient structures on the regeneration of alveolar bone defect: A comprehensive study","volume":"10","author":"Yang","year":"2022","journal-title":"Front Bioeng Biotechnol"},{"key":"R14-20250710","doi-asserted-by":"crossref","first-page":"202","DOI":"10.11607\/prd.6469","article-title":"Management of curved bone defects in the anterior maxilla using bone bending via a kerfed khoury split bone block technique","volume":"43","author":"Gluckman","year":"2023","journal-title":"Int J Periodontics Restorative Dent"},{"key":"R15-20250710","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1055\/s-0032-1320066","article-title":"Treacher collins 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