title: Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: correlation between volume changes and respiratory outcome.
abstract: In syndromic craniosynostosis patients, respiratory insufficiency may be a pressing indication to surgically increase the patency of the upper airway by midface or monobloc advancement. In this study the volume changes of the upper airway and the respiratory outcome following midface (Le Fort I or III) or monobloc advancement in ten syndromic craniosynostosis patients are evaluated. Pre- and postoperatively, the airway volume was measured using a semi-automatic region growing method. Respiratory data were correlated to the volume measurements. In nine patients the outcome of upper airway volume measurements correlated well to the respiratory outcome. Three of these patients showed a minimal airway volume gain or even volume loss, and no respiratory improvement was found. In one monobloc patient improvement of the respiratory outcome without an evident volume gain of the upper airway was found. The majority of patients with Le Fort III advancement showed respiratory improvement, which for the greater part correlated to the results of the volume analysis. In monobloc patients the respiratory outcomes and volume measurements were less obvious. Preoperative endoscopy of the upper airway is advocated to identify the level of obstruction in patients with residual obstructive sleep apnoea.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, The Netherlands. e.nout@erasmusmc.nl
authors.forename: Erik
authors.initials: E
authors.lastname: Nout
authors.forename: Natalja
authors.initials: N
authors.lastname: Bannink
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Koudstaal
authors.forename: Jifke F
authors.initials: JF
authors.lastname: Veenland
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
authors.forename: Rene M L
authors.initials: RM
authors.lastname: Poublon
authors.forename: Karel G H
authors.initials: KG
authors.lastname: van der Wal
authors.forename: Irene M J
authors.initials: IM
authors.lastname: Mathijssen
authors.forename: Eppo B
authors.initials: EB
authors.lastname: Wolvius
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery*; D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis; D002508:Cephalometry / Q000379:methods; D002648:Child; D015331:Cohort Studies; D003394:Craniofacial Dysostosis / Q000601:surgery*; D004724:Endoscopy; D005147:Facial Bones / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007013:Hypopharynx / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation; D009296:Nasal Cavity / Q000000981:diagnostic imaging; D009305:Nasopharynx / Q000000981:diagnostic imaging; D009960:Oropharynx / Q000000981:diagnostic imaging; D019857:Osteogenesis, Distraction / Q000379:methods; D019340:Osteotomy, Le Fort / Q000145:classification; D010614:Pharynx / Q000000981:diagnostic imaging / Q000473:pathology*; D017286:Polysomnography / Q000379:methods; D012119:Respiration; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D014139:Tracheostomy; D016896:Treatment Outcome; D055815:Young Adult