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Three-dimensional airways reconstruction in syndromic pedriatric patients following mandibular distraction
Giuseppe Spinelli1, Tommaso Agostini, Francesco Arcuri
1Department of Maxillo-Facial Surgery, CTO-AOUC, University of Florence, Florence, Italy.
Insights
Surgery significantly improved airway volumes in pediatric patients with mandibular hypoplasia, leading to tracheostomy removal in most cases. This intervention enhances breathing and quality of life.
Area of Science:
- Medical engineering
- Pediatric surgery
- Respiratory medicine
Background:
- Airway obstruction is common in pediatric patients with mandibular hypoplasia, presenting as positional obstruction to severe respiratory distress.
- Management is complex due to the young age of patients.
- Syndromic conditions often involve mandibular hypoplasia and airway compromise.
Purpose of the Study:
- To evaluate the surgical success in expanding respiratory volumes for pediatric patients with mandibular hypoplasia.
- To assess the feasibility of preventing or removing tracheostomy in these patients.
Main Methods:
- Twelve pediatric patients with mandibular hypoplasia and respiratory distress underwent surgical treatment.
- Respiratory volumes were measured using computer tomography (CT) and analyzed with SimPlant Pro 15 software.
- Preoperative tracheostomy status was noted, with the goal of decannulation or avoidance.
Main Results:
- Significant increases in airway volume (average 279.2%) and surface area (average 89.4%) were observed post-surgery.
- Tracheostomy was successfully avoided in one patient and removed in ten patients.
- One patient experienced failure in airway volume augmentation, and tracheostomy was not removed.
Conclusions:
- Computer tomography provides accurate airway measurements in three planes (coronal, sagittal, axial).
- Surgical airway augmentation improved sleep and breathing, enabling tracheostomy removal and enhancing quality of life for most patients.
- 3D airway reconstruction is a valuable tool for assessing surgical outcomes in mandibular hypoplasia.
Background:
Airway obstruction, associated with mandibular hypoplasia, is a frequent complication in syndromic pediatric patients. The clinical signs of airway obstruction change from mild positional obstruction to severe respiratory distress with cyanosis. The young age of the patients makes medical management extremely complex.
Methods:
The purpose was to evaluate the success of surgery, evaluating the expansion of the respiratory volumes measured by computer tomography analyzed through a software (SimPlant Pro 15). Twelve patients with mandibular hypoplasia and respiratory distress were treated between December 2010 and December 2013. Eleven of them had tracheostomy in the preoperative period. The goal of surgery was to prevent permanent tracheostomy or to remove it, if present.
Results:
Volume and surface area increased by an average of 279.2% and 89.4%, respectively. Tracheostomy was avoided in 1 patient who underwent surgery precociously, and it was removed in 10 patients. Only 1 case failed in volume airway augmentation, and tracheostomy was not removed.
Conclusions:
Computer tomography can calculate the cross-sectional areas of the airway in 3 planes of space: coronal, sagittal, and axial. In most patients, changes in airways have been accompanied by improvements in sleep and breathing, allowing for the removal of tracheostomy with an improved quality of life. Three-dimensional reconstruction of airways revealed a useful tool to better understand the success of surgery.
Level Of Evidence:
IV.
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A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...