Syndromic craniosynostosis: complicated airway obstruction calls for progressive strategies in surgical management

Abstract

Evaluation of: Bannink N, Nout E, Wolvius EB, Hoeve HL, Joosten KF, Mathijssen IM. Obstructive sleep apnea in children with syndromic craniosynostosis: long-term respiratory outcome of midface advancement. Int. J. Oral Maxillofac. Surg. 39(2), 115–121 (2010).

Children with syndromic craniosynostosis are at high risk for upper airway obstruction due to midface hypoplasia. Le Fort III osteotomy with midface advancement can expand the naso- and palatopharynx and potentially relieve obstruction. Short-term success has been demonstrated with these surgical techniques; however, little is known regarding the long-term effect of midface advancement on maintaining airway patency. The purpose of this study was to evaluate the long-term effect of midface advancement for treatment of severe obstructive sleep apnea in patients with syndromic craniosynostosis. Results showed that midface advancement had short-term (4 months) success in six of 11 patients with resolution of the need for positive airway pressure, tracheostomy or oxygen (54%); however, long-term success was maintained in only four of these six patients. All failures had concomitant hypopharyngeal obstruction, which cannot be corrected by midface advancement. Endoscopy and 3D CT scan may be useful for predicting which patients will require additional surgical procedures, such as mandibular or genio-hyoid advancement.

Keywords::

• craniosynostosis
• distraction osteogenesis
• Le Fort III
• obstructive sleep apnea

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.