title: Early midfacial distraction for syndromic craniosynostotic patients with obstructive sleep apnoea.
abstract: Syndromic craniosynostosis is known to be associated with various obstructive respiratory disorders, including sleep apnoea. We performed early midfacial distraction in 11 syndromic craniosynostotic patients with obstructive respiratory apnoea and obtained good results. There were four patients with Crouzon syndrome, three patients with Pfeiffer syndrome and four patients with Apert syndrome. Their ages ranged from 7 months to 3 years, 9 months (mean: 2 years, 5 months). Midfacial distraction was performed using an internal or external device to improve obstructive respiratory disorders, such as sleep apnoea, and to avoid tracheostomy. Evaluation was performed by comparison of the pre- and postoperative polysomnograms (PSGs) and cephalograms. All patients had markedly improved respiratory disorders during sleep and avoided tracheostomy. Preoperative PSGs and cephalograms were compared with those from 1 year to 1 year, 6 months postoperatively. The postoperative PSGs and cephalograms showed marked improvements compared with preoperative PSGs and cephalograms. Syndromic craniosynostotic patients have facial bone hypoplasia, particularly of the maxilla. The tongue and parapharyngeal soft tissue become enlarged, and the enlarged tissues can cause airway obstruction. In this study, marked improvements were observed in physical evaluation using PSGs and morphological evaluation using cephalograms. Early midfacial distraction is thought to be a very useful method to reconstruct a large pharyngeal cavity, enlarge the airway, improve obstructive respiratory disorders and to avoid tracheostomy. It is important to select a device suitable for each case when surgery and distraction are performed.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan. nmitsu@air.linkclub.or.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mitsukawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Atsuomi
authors.initials: A
authors.lastname: Saiga
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Akita
authors.forename: Kaneshige
authors.initials: K
authors.lastname: Satoh
mesh_terms: D000168:Acrocephalosyndactylia / Q000175:diagnosis / Q000601:surgery; D000367:Age Factors; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000175:diagnosis / Q000601:surgery; D003398:Craniosynostoses / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D061214:Patient Safety; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011859:Radiography; D018570:Risk Assessment; D012494:Sampling Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Distraction device; Early midfacial distraction osteogenesis; Obstructive sleep apnoea; Syndromic craniosynostosis; Tracheostomy