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Respiratory and volumetric changes of the upper airways in craniofacial synostosis patients

Giuditta Mannelli1, Francesco Arcuri2, Barbara Spacca3

  • 1Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|February 26, 2019
PubMed

Insights

Le Fort III (LFIII) surgery with distraction osteogenesis (DO) significantly improved upper airway volume and respiratory function in pediatric syndromic craniosynostosis (SCS) patients. Further sleep endoscopy is recommended to assess residual airway obstruction.

Area of Science:

  • Craniofacial Surgery
  • Pediatric Otolaryngology
  • Respiratory Medicine

Background:

  • Syndromic craniosynostosis (SCS) often involves complex upper airway abnormalities.
  • Le Fort III (LFIII) advancement with distraction osteogenesis (DO) is a surgical approach to address these issues.
  • Assessing the impact of LFIII-DO on upper airway dimensions and respiratory function is crucial for pediatric patients.

Purpose of the Study:

  • To evaluate postoperative changes in upper airway volume and respiratory parameters in pediatric SCS patients.
  • To determine the efficacy of LFIII or frontofacial advancement by DO in improving airway obstruction.
  • To correlate changes in airway volume with improvements in polysomnography (PSG) data.

Main Methods:

  • Retrospective chart review of 25 pediatric SCS infants undergoing LFIII or frontofacial advancement by DO.
  • Preoperative (T0) and postoperative (T1) three-dimensional computed tomography (3D-CT) for airway volume measurement.
  • Preoperative (T0) and postoperative (T1) polysomnography (PSG) for respiratory parameter assessment.

Main Results:

  • 18 patients were included in the analysis.
  • Mean upper airway volume significantly increased from 15.963 mm³ (T0) to 24.550 mm³ (T1) (p < 0.05).
  • A global 72.22% improvement in respiratory parameters was observed postoperatively, with a median airway area increase of 8.004 mm³.

Conclusions:

  • LFIII advancement by DO provides a statistically significant gain in upper airway dimensions for SCS patients.
  • While airway volume increases, the direct relationship with Obstructive Sleep Apnea Syndrome (OSAS) improvement requires further investigation.
  • Sleep endoscopy is recommended for a comprehensive assessment of residual or recurrent upper airway obstruction post-surgery.

Keywords:
Airway volumes analysisFrontofacial advancementLe Fort III osteodistractionPolysomnographySyndromic cranial-synostosis

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