Three-dimensional airway changes after Le Fort III advancement in syndromic craniosynostosis patients.
BACKGROUND
To investigate the changes of upper airway volume in syndromic craniosynostosis patients following Le Fort III advancement, computed tomographic scans were analyzed and related to the amount of advancement.


METHODS
In this retrospective study, the preoperative and postoperative computed tomographic scans of 19 patients with syndromic craniosynostosis who underwent Le Fort III advancement were analyzed. In four cases, preoperative polysomnography demonstrated obstructive sleep apnea. The airway was segmented using a semiautomatic region growing method with a fixed Hounsfield threshold value. Airway volumes of hypopharynx and oropharynx (compartment A) and nasopharynx and nasal cavity (compartment B) were analyzed separately, as was the total airway volume. Advancement of the midface was recorded using lateral skull radiographs. Data were analyzed for all patients together and for patients with Crouzon/Pfeiffer and Apert syndromes separately.


RESULTS
Airway volume increased significantly in compartment A (20 percent; p = 0.044) and compartment B (48 percent; p < 0.001), as did total airway volume in (37 percent; p < 0.001) in the total study group. No significant differences in volume changes were found comparing Apert with Crouzon/Pfeiffer patients. No distinct relation could be found between advancement of the midface and volume gain either in the total study group or in Apert and Crouzon/Pfeiffer patient groups separately. Postoperative polysomnography showed significant improvement of obstructive sleep apnea in all four patients.


CONCLUSIONS
A significant improvement of the upper airway after Le Fort III advancement in syndromic craniosynostosis patients is demonstrated. No distinct relation could be observed between advancement and airway volume changes.
Nout
Erik
E
Rotterdam, The Netherlands From the Departments of Oral and Maxillofacial Surgery, Radiology, and Plastic and Reconstructive Surgery, and the Departments of Medical Informatics and Biostatistics, Faculty of Medicine, Erasmus MC University Medical Center.
Bouw
Frederik P
FP
Veenland
Jifke F
JF
Hop
Wim C J
WCJ
van der Wal
Karel G H
KGH
Mathijssen
Irene M J
IMJ
Wolvius
Eppo B
EB
D000168:Acrocephalosyndactylia / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000402:Airway Obstruction / Q000517:prevention & control*; D056151:Airway Remodeling / Q000502:physiology*; D002508:Cephalometry; D002648:Child; D015331:Cohort Studies; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000502:physiology; D015508:Nasal Obstruction / Q000517:prevention & control; D009305:Nasopharynx / Q000502:physiology; D015588:Observer Variation; D019340:Osteotomy, Le Fort / Q000379:methods*; D017286:Polysomnography; D011336:Probability; D012119:Respiration; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome