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Perioperative Care for Children With Syndromic Craniofacial Synostosis Undergoing Le Fort III Surgery: A
Andrea Restivo1, Egle Rondelli2, Marco Giani1,2
1Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca.
Insights
Le Fort III osteotomy for craniofacial synostosis in children involves complex surgery with significant blood loss and transfusion needs. However, with a multidisciplinary approach, complications are minimized, ensuring a safe recovery.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Genetics
Background:
- Craniofacial synostoses are genetic syndromes causing premature suture fusion, leading to deformities.
- Le Fort III osteotomy is the primary surgical intervention for midface advancement in these conditions.
- Understanding perioperative management is crucial for patient outcomes.
Purpose of the Study:
- To detail the perioperative characteristics of pediatric patients undergoing Le Fort III osteotomy.
- To analyze surgical variables, complications, and postoperative care.
- To evaluate the safety and efficacy of this procedure in a specialized center.
Main Methods:
- Retrospective monocentric cohort study (2009-2022).
- Inclusion of pediatric patients with syndromic craniofacial synostosis.
- Data collection on surgical time, blood loss, transfusions, fluid balance, ventilation, and ICU stay.
Main Results:
- Twenty-six children analyzed; median surgical time 345 minutes.
- Significant blood loss (15 mL/kg) and transfusion requirements (PRBCs and FFP).
- Low complication rate, including one extubation failure; median ICU stay of 2 days.
Conclusions:
- Le Fort III osteotomy presents a complex perioperative course in craniofacial synostosis.
- A multidisciplinary approach is key to minimizing perioperative complications.
- Further research is needed for optimized perioperative management in this population.
Objective:
To present characteristics, surgical variables, complications, and postoperative care in pediatric patients with craniofacial synostosis undergoing Le Fort III osteotomy.
Background:
Craniofacial synostoses are a group of genetic syndromes that result in premature fusion of cranial and facial sutures, leading to craniofacial deformities and associated complications. Midface advancement through Le Fort III osteotomy is the most frequent surgical option for these conditions.
Methods:
Retrospective monocentric cohort study including patients with syndromic craniofacial synostosis who underwent Le Fort III osteotomy between 2009 and 2022 in a specialized referral center. Data collection encompassed surgical time, blood loss, intraoperative transfusions, fluid balance, and postoperative parameters such as duration of invasive mechanical ventilation and intensive care unit (ICU) length of stay.
Results:
Twenty-six children were included in the analysis. The median surgical time was 345 minutes (300-360), with an estimated blood loss of 15 (9.9-24) mL/kg. Patients required a median transfusion of 12.63 (7.1-24.5) mL/kg of packed red blood cells and 19.82 (11.1-33) mL/kg of fresh frozen plasma. Intraoperative fluid balance was + 12.5 (0.8-22.8) mL/kg, with a median infusion of 30.4 (23.9-38.7) mL/kg of crystalloids. All patients were transferred to the ICU after surgery to ensure a safe environment for extubation. The median duration of mechanical ventilation in the ICU was 30 (20.25-45) hours, and postoperative ICU length of stay was 2 (2-4) days, and complications were infrequent, with only one extubation failure recorded.
Conclusion:
Le Fort III osteotomy in craniofacial synostosis patients may be characterized by a complex perioperative course. A multidisciplinary approach in the care of these patients allows for minimizing complications in the perioperative phase. Further research is needed to enhance perioperative management in this unique patient population.
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