Document Detail


Effect of midfacial distraction on the obstructed airway in patients with syndromic bilateral coronal synostosis.
MedLine Citation:
PMID:  18940499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Le Fort III osteotomy and midfacial advancement expand the nasopharynx and potentially increase airway dimensions in patients with syndromic bilateral coronal synostosis. Distraction osteogenesis allows greater midfacial advancement, and may offer more improvement in airway obstruction, compared with the conventional 1-stage procedure. This study aimed to document the effect of midfacial distraction-advancement on airway obstruction in patients with syndromic bilateral coronal synostosis. PATIENTS AND METHODS: Charts of patients with syndromic bilateral coronal synostosis who had undergone Le Fort III distraction were reviewed. Preoperative and postoperative demographic, cephalometric, polysomnographic, and subjective patient/parental reported data were reviewed. Descriptive and nonparametric bivariate statistics were computed, to document changes in airway parameters. RESULTS: Of 25 patients who underwent midfacial Le Fort III distraction, only 18 had preoperative airway obstruction. The mean age at operation for patients with airway obstruction was (+/-SD) 10.4 +/- 4.2 years (range, 2.7 to 17.4 years), and the average advancement was 20.5 +/- 7.4 mm (range, 10 to 30 mm). Five of 6 patients with a tracheostomy were decannulated; 1 patient had persistent central apnea that prevented decannulation. The mean respiratory distress index for the group improved from 33.4 +/- 37.57 (range, 1.8 to 109.2) to 12.6 +/- 26.32 (range, 0.00 to 72.0) (P < .05). Six of 9 patients no longer required continuous or bilevel positive airway pressure. All patients reported decreased snoring (P < .05). CONCLUSIONS: Midfacial distraction improves airway obstruction in patients with syndromic bilateral coronal synostosis. Clinicians can counsel patients and families that this procedure usually permits decannulation and discontinuation of continuous or bilevel positive airway pressure.
Authors:
Tyler E Nelson; John B Mulliken; Bonnie L Padwa
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons     Volume:  66     ISSN:  1531-5053     ISO Abbreviation:  J. Oral Maxillofac. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-22     Completed Date:  2008-11-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8206428     Medline TA:  J Oral Maxillofac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2318-21     Citation Subset:  AIM; D; IM    
Affiliation:
Harvard School of Dental Medicine, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Airway Obstruction / surgery*
Child
Child, Preschool
Craniosynostoses / surgery*
Facial Bones / surgery*
Female
Frontal Bone / surgery
Humans
Male
Maxilla / surgery
Nasopharynx / pathology
Osteogenesis, Distraction*
Osteotomy, Le Fort
Polysomnography
Retrospective Studies
Sleep Apnea, Obstructive / surgery
Syndrome
Treatment Outcome
Zygoma / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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