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Airway disorders in hemifacial microsomia
S R Cohen1, C A Levitt, C Simms
1Center for Craniofacial Disorders at Scottish Rite Children's Medical Center, and Emory University School of Medicine, Atlanta, GA, USA.
Plastic and Reconstructive Surgery
|January 23, 1999
Summary
Hemifacial microsomia patients have a high incidence of airway disorders, with nearly 24% experiencing obstructive sleep apnea. Severe mandibular and orbital deformities increase this risk, necessitating routine screening for sleep apnea.
Area of Science:
- Craniofacial abnormalities
- Sleep Medicine
- Otolaryngology
Background:
- Hemifacial microsomia (HFM) is a congenital condition with diverse anatomical manifestations.
- Previous classifications of HFM focused on anatomical components, not functional implications like airway disorders.
- The prevalence and severity of airway obstruction and obstructive sleep apnea (OSA) in HFM patients remain underreported.
Purpose of the Study:
- To determine the frequency and severity of airway disorders in patients with hemifacial microsomia.
- To identify anatomical and syndromic factors associated with increased risk of upper airway obstruction and OSA in HFM.
- To establish the need for routine OSA screening in HFM patients.
Main Methods:
- Retrospective study of 38 patients diagnosed with hemifacial microsomia.
- Patients aged 6 months to 22 years.
- Classification of airway disorders into three groups: asymptomatic, suspected OSA/perioperative apnea, and definite OSA/obstruction.
Main Results:
- 58% of patients were asymptomatic for airway disorders.
- 18% had symptoms suggestive of intermittent OSA or perioperative apnea.
- 24% had a confirmed history of OSA or upper airway obstruction requiring intervention.
- Severe mandibular and orbital deformities were associated with a higher risk of OSA.
- OMENS-Plus (extracraniofacial anomalies) was more common in patients with airway issues.
- Cardiac anomalies were more frequent in patients with definite OSA.
Conclusions:
- A significant portion of hemifacial microsomia patients experience airway disorders, including a notable incidence of obstructive sleep apnea.
- Patients with more severe mandibular and orbital deformities are at greater risk for OSA.
- Routine screening for obstructive sleep apnea is recommended for all patients with hemifacial microsomia, with positive findings warranting further polysomnographic and anatomical evaluation.