The Effect of Midface Advancement Surgery on Obstructive Sleep Apnoea in Syndromic Craniosynostosis

Saxby, Clair; Stephenson, Kate; Steele, Katherine; Ifeacho, Sonna; Wyatt, Michelle; Samuels, Martin

doi:10.1097/scs.0000000000004105

Cited by 15 publications

(14 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Saxby et al [74] evaluated maxillomandibular advancement surgery as the gold standard for children affected by syndromic craniofacial abnormalities. The procedure showed an improvement of the Apnea-Hypopnea Index score and OSA grading in most of their 65 patients, although measures of oxygenation revealed no differences.…”

Section: Risk Factorsmentioning

confidence: 99%

Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art

Gulotta

Iannella

Vicini

et al. 2019

IJERPH

145

135

View full text Add to dashboard Cite

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management.

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art

Gulotta

Iannella

Vicini

et al. 2019

IJERPH

145

135

View full text Add to dashboard Cite

show abstract

“…25 This may be an underlying reason why there was no obvious improvement of respiratory difficulties, despite overcorrection of midface hypoplasia. 4,[26][27][28][29][30] For type II Apert syndrome patients, although the midface advancement, such as the Lefort III and monobloc, can have a beneficial effect in increasing the hypopharynx and oropharynx volume as a byproduct, but the greatest potential for airway improvement is in the nasopharynx and nasal cavity. 25,30 Direct surgical intervention, such as mandibular advancement, to correct the limited transverse dimensions of pharyngeal airway, may be, as well, of greater functional benefit.…”

Section: Discussionmentioning

confidence: 99%

Airway Development Relevant to Cranial Vault Suture Synostosis Subtype in Apert Syndrome

Forte

Park

et al. 2020

FACE

View full text Add to dashboard Cite

Introduction: Based on an established classification system of Apert syndrome subtypes, we aim to directly analyze the correlation between segmented airway volume changes and different skull suture synostosis, so as to provide individualized surgical planning for each subgroup of Apert patients. Methods: CT scans of 44 unoperated Apert syndrome and 53 controls were included and subgrouped as: type I. Bilateral coronal synostosis; type II. Pansynostosis; type III. Perpendicular combinations of cranial vault synostosis. CT scans were measured using Mimics and 3-matics software. Results: Type I developed a 41% ( P = .116) reduction in the nasal cavity, yet a normal sized pharyngeal airway. The reduced nasal airway was linked to the decreased cross sectional area ( r = 0.598, P = .001), vertical dimension ( r = 0.719, P < .001), and narrower width ( r = 0.727, P < .001). Type II developed proportionally reduced nasal airway and pharyngeal airway volumes (both 47%, P = .113 and P = .041), along with the proportionally restricted cross sectional areas at choana and condylion levels by 62 to 65%. This reduction is related to the cranial base length ( r = 0.712, P = .048), and also cranial base angulation ( r = 0.780, P = .023). Nasal and pharyngeal airway developed normal volume in type III. However, the cross sectional areas at the gonion level diminished by 74% ( P < .001). Conclusion: Airway development is influenced by subtype of Apert suture synostosis. Type II pansynostosis Apert patients developed synchronous reduced nasal and pharyngeal airways, which is correlated with the slightly flattened cranial base. Type I bicoronal patients have a smaller nasal cavity, but normally sized hypopharynx. Yet, type III patients developed normal nasopharyngeal airway volume overall.

show abstract

“…16 While adenotonsillectomy may help, it does not address midface hypoplasia and retrusion itself, nor any impact from mandibular hypoplasia, if present. 13 Thus, other options may be required to fully relieve an obstructed airway. These options include midface advancement surgery or mandibular distraction.…”

Section: Initial Managementmentioning

confidence: 99%

“…The success of midface advancement surgery has been variable, with consistent improvement in AHI and OSA symptoms not always seen. 13 This may be in part due to the rarity of the condition and heterogenous group that comprises craniosynostosis patients. 78 Practice guidelines addressing le Fort and monobloc advancement procedures state that these interventions are likely to provide some improvement in upper airway problems, and may help patients wean off of a tracheostomy, thus can be considered, particularly in severe patients.…”

Section: Initial Managementmentioning

confidence: 99%

“…11,12 The hypoplastic midface may impinge on the nasopharynx, increasing the risk of airway collapse. 12,13 Management depends on severity and may include pharmacologic treatment with nasal corticosteroids or antibiotics, placement of a nasopharyngeal tube to improve nasopharyngeal crowding, FACE 2 (4) application of nocturnal oxygen or continuous or bi-level positive airway pressure (CPAP or BiPAP), as well as surgical intervention with adenotonsillectomy, midface advancement, or tracheostomy. 11,13,14 In single-stage midface advancement, there has been variable relief of OSA symptoms, while gradual distraction may provide greater resolution.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Childhood Obstructive Sleep Apnea, What a Surgeon Should Know. Part 1: Interpreting the Polysomnography Study; Part 2: Diagnosis and Management

Smearman

Williams

2021

FACE

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) and disordered breathing can be common in early development with certain conditions placing children at increased risk for OSA, such as micrognathia and the Pierre Robin sequence, craniosynostosis, and tonsillar hypertrophy. A Level 1 Sleep Study evaluation is recommended in all children with suspected sleep apnea. Part 1 of this review provides a discussion of the polysomnography study and interpretation. Part 2 focuses on diagnosis and management, emphasizing conditions that are amendable to surgical intervention and the impact of intervention on post-operative sleep study outcomes.

show abstract

The Effect of Midface Advancement Surgery on Obstructive Sleep Apnoea in Syndromic Craniosynostosis

Abstract: The authors report one of the largest reviews of the effects of midface advancement surgery on sleep study parameters. Most patients showed improvements in Apnoea-Hypopnoea Index and OSA grading, although measures of oxygenation showed no consistent change.

Cited by 15 publications

References 23 publications

Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art

Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art

Airway Development Relevant to Cranial Vault Suture Synostosis Subtype in Apert Syndrome

Childhood Obstructive Sleep Apnea, What a Surgeon Should Know. Part 1: Interpreting the Polysomnography Study; Part 2: Diagnosis and Management

Contact Info

Product

Resources

About