Airway changes after Le Fort III osteotomy in craniosynostosis syndromes

The purpose of this study was to investigate changes in the nasopharyngeal airway and surrounding structures after Le Fort III advancement in Apert's and Crouzon's syndromes. Sixteen status post Le Fort III osteotomy Apert's and Crouzon's patients with pre- and postoperative lateral cephalograms were evaluated. The cephalograms were traced, and linear and angular measurements were obtained. Pre- and postoperative data were compared using a Student's paired t-test. The correlation between changes in the nasopharyngeal airway and its surrounding skeletal structures was evaluated. Finally, the study subjects were divided into two groups--Apert's and Crouzon's--and preoperative measurements from each group were compared with normal data by a Student's paired t-test. Significant improvement in the nasopharyngeal airway followed Le Fort III advancement, with changes in both hard and soft tissues. There was no change in the pharyngeal airway, even though a decrease might be predicted because of the clockwise rotation of the mandible. The morphology of the impairment in the nasopharyngeal airway differed between Apert's and Crouzon's syndrome individuals. Our results suggest that, for the purpose of airway improvement, the midface should be mainly advanced in the Crouzon's syndrome individual, whereas the downward component of the movement should be predominant in the Apert's syndrome individual.