Early midfacial distraction for syndromic craniosynostotic patients with obstructive sleep apnoea

Mitsukawa, Nobuyuki; Kaneko, Tsuyoshi; Saiga, Atsuomi; Akita, Shinsuke; Satoh, Kaneshige

doi:10.1016/j.bjps.2013.04.061

Cited by 28 publications

(20 citation statements)

References 10 publications

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“…There was significant improvement of the OSA from severe to mild with this intervention (40). The same group also reported promising outcomes in children who had early (mean age: 2 years 5 months) midface distraction: all 11 patients avoided tracheostomy and had significant improvements in their post-operative PSG studies and cephalogram findings (41). …”

Section: Surgical Midface Advancementmentioning

confidence: 90%

Craniofacial syndromes and sleep-related breathing disorders

Tan

Kheirandish‐Gozal

Abel

et al. 2016

Sleep Medicine Reviews

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Summary Children with craniofacial syndromes are at risk of sleep disordered breathing, the most common being obstructive sleep apnea. Midface hypoplasia in children with craniosynostosis and glossoptosis in children with Pierre Robin syndrome are well recognized risk factors, but the etiology is often multifactorial and many children have multilevel airway obstruction. We examine the published evidence and explore the current management strategies in these complex patients. Some treatment modalities are similar to those used in otherwise healthy children such as as adenotonsillectomy, positive pressure ventilation and in the refractory cases, tracheostomy. However, there are some distinct approaches such as nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis in children with Pierre Robin sequence, and midface advancement in children with craniosynostoses. Clinicians should have a low threshold for referral for evaluation of sleep-disordered-breathing in these patients.

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Section: Surgical Midface Advancementmentioning

confidence: 90%

Craniofacial syndromes and sleep-related breathing disorders

Tan

Kheirandish‐Gozal

Abel

et al. 2016

Sleep Medicine Reviews

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“…Other methods exist, including using an external transfacial pin for distraction. One study found that midface distraction substantially reduced the AHI and improved the oxygen saturation in a cohort of 11 young children with Pfeiffer, Cruzon, or Apert syndrome and severe OSAS 44 .…”

Section: Therapies For Osas In the Paediatric Craniofacial Populationmentioning

confidence: 99%

Obstructive sleep apnoea in children with craniofacial syndromes

Cielo

Marcus

2015

Paediatric Respiratory Reviews

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Summary Obstructive sleep apnoea syndrome (OSAS) is common in children. Craniofacial anomalies such as cleft palate are among the most common congenital conditions. Children with a variety of craniofacial conditions, including cleft palate, micrognathia, craniosynostosis, and midface hypoplasia are at increased risk for OSAS. Available evidence, which is largely limited to surgical case series and retrospective studies, suggests that OSAS can be successfully managed in these children through both surgical and non-surgical techniques. Prospective studies using larger cohorts of patients and including polysomnograms are needed to better understand the risk factors for this patient population and the efficacy of treatment options for OSAS and their underlying conditions.

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“…26 Studies report the use of early MFA in syndromic craniosynostoses in preventing the need for a tracheostomy and improving OSA. [26][27][28][29] In our center, it is our practice to delay MFA to the age of 8 years and above. We have only had 1 patient requiring an early MFA to manage OSA.…”

Section: Discussionmentioning

confidence: 99%

Management of the Airway in Apert Syndrome

Xie

Selby

2016

Journal of Craniofacial Surgery

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The management of the airway in Apert syndrome is complex and multidisciplinary. This rare syndrome, occurring in up to approximately 1 in 65,000 live births, results in airway compromise at various anatomic levels, in addition to abnormal central respiratory drive. Obstructive apneas arise because of decreased airway caliber, which may occur in the form of congenital bony nasal stenosis, choanal atresia, a deviated nasal septum, a narrowed nasopharynx, a thick long soft palate, lateral palatal swellings, and a tracheal cartilage sleeve. Central apneas in Apert syndrome arise because of raised intracranial pressure and/or Chiari malformations. The purpose of this study was to investigate our treatment methods and outcomes in optimizing the airway in this complex, rare and interesting cohort of patients who present with airway compromise. Patients with Apert syndrome were retrospectively evaluated during a period from 1990 to 2013. Treatments for obstructive apnea were dilatation of nasal airways and choanal atresia repair, adenoidectomy, tonsillectomy, early midface advancement, and noninvasive ventilation. The insertion of ventriculoperitoneal shunts, fronto-orbital advancement, and Chiari decompression aid in managing central apneas. The authors present our experience at Alder Hey Children's Hospital, Liverpool, one of the 4 Supraregional Craniofacial Units in the United Kingdom.

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Early midfacial distraction for syndromic craniosynostotic patients with obstructive sleep apnoea

Cited by 28 publications

References 10 publications

Craniofacial syndromes and sleep-related breathing disorders

Craniofacial syndromes and sleep-related breathing disorders

Obstructive sleep apnoea in children with craniofacial syndromes

Management of the Airway in Apert Syndrome

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