Treatment of the Syndromic Midface

Patel, Niyant; Fearon, Jeffrey A.

doi:10.1097/prs.0000000000001062

Cited by 38 publications

(15 citation statements)

References 15 publications

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“…[5][6][7]25 Patel reported stable results with mild horizontal advancement and greater vertical development following LeFort III distraction. 6 Bachmayer compared maxillary growth in normal controls, unoperated craniofacial dysostoses, and craniofacial dysostoses patients who underwent traditional LeFort III. 26 He indicated that traditional LeFort III had adverse growth effects and demonstrated horizontal maxillary growth of 1.3 mm/ year in controls, mm/year in unoperated craniofacial dysostosis, and <0.1 mm/year in the LeFort III group.…”

Section: Discussionmentioning

confidence: 96%

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Monobloc Differential Distraction Osteogenesis

Polley

Figueroa²,

Girotto

et al. 2021

Journal of Craniofacial Surgery

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Midface advancement at the monobloc level can be the seminal life event for patients with craniofacial dysostosis. Monobloc reconstruction, when planned appropriately, can simultaneously and definitively address multiple functional and aesthetic deficiencies in these patients. The application of distraction has reduced the morbidity experienced with traditional monobloc surgery. The purpose of this study is to report on the outcomes, stability, and growth in younger patients after monobloc advancement in syndromic craniosynostosis patients. The authors report a consecutive series of thirty patients with craniofacial dysostosis treated through monobloc differential distraction osteogenesis. Detailed history, photographic, and long-term radiographic data are reviewed, including a subset of patients who were skeletally immature at the time of their treatment. Differential distraction allows control of midface pitch, roll, and yaw, optimizing functional and aesthetic outcomes. There were no infectious complications requiring reoperation. The average surgical age for all patients was 12.5 years. For the 7 patients age <7 years, average age was 6 years. For all patients, the mean horizontal movement was 12 mm at nasion and 10 mm at A-point. At mean follow-up (4.8 years entire group and 6.2 years age <7 years group) a positive horizontal advancement of 1.1 mm at nasion and 0.8 mm at A-point was observed. More pronounced positive horizontal changes were seen in the age <7 years group. Monobloc differential distraction osteogenesis affords safe and precise repositioning of the midface. The advancement is skeletally stable and young patients show moderate continued growth.

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Section: Discussionmentioning

confidence: 96%

“…Reports on skeletal stability following midface distraction have focused primarily at the LeFort III level showing limited or no skeletal relapse 5–7 . Reports on midface stability following monobloc distraction have been limited 9,10,12 .…”

Section: Discussionmentioning

confidence: 99%

Monobloc Differential Distraction Osteogenesis

Polley

Figueroa²,

Girotto

et al. 2021

Journal of Craniofacial Surgery

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“…3 Two patients (20%) developed recurrent obstructive sleep apnea, and one patient developed de novo obstructive sleep apnea. 3 They discussed the need for continued vigilance for ventilatory impairment following midfacial advancement in growing children. It is commonly recognized that most children with syndromic synostosis will require more than one midfacial advancement over a lifetime.…”

Section: Discussionmentioning

confidence: 99%

“…It is commonly recognized that most children with syndromic synostosis will require more than one midfacial advancement over a lifetime. 3 Because patients with syndromic craniosynostosis or other congenital anomalies with repeated recurrent sleep apnea have already undergone major osteotomy several times and have completed orthodontic treatment, it is difficult to perform another major osteotomy because of impairment of occlusion. Surgery for OSA is classified into phase Ⅰ soft tissue surgery and phase Ⅱ skeletal surgery.…”

Section: Discussionmentioning

confidence: 99%

Useful Genioplasty for Repeated Recurrent Sleep Apnea of Congenital Anomalies and Its Evaluation

Kino

Ueda

Hirota

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Congenital facial anomalies with hypoplasia of the midface or lower face are associated with obstructive apnea syndrome. Although such patients underwent bone advancement surgery and their sleep apnea improved in the short term, it often recurred several years after surgery. It is difficult to perform another major osteotomy because of impairment of the facial contour or prior orthodontic treatment. Genioplasty was performed for genioglossus muscle advancement in patients with congenital anomalies and repeated sleep apnea. In this study, we evaluated the usefulness of this procedure and the mechanism for the improvement of sleep apnea. Methods: Six patients were included: three with syndromic craniosynostosis, two with Treacher-Collins syndrome, and one with micrognathia by Goldenhar syndrome. Patients who had recurrence of sleep apnea after previous maxillomandibular osteotomies, or advancement and orthodontic treatment, received genioplasty for genioglossus muscle advancement. The patients were evaluated by body mass index, simple polysomnography, hyoid bone position on cephalogram, and the airway area on computed tomography images pre- and postoperatively. Results: Polysomnography showed a significant improvement in the apnea-hypopnea index. Cephalometric measurement showed significant results of the hyoid bone position from point B and the ramus plane. However, no significant results were obtained in the airway area assessment. Conclusions: Genioplasty for genioglossus muscle advancement can improve apnea-hypopnea index by moving the hyoid bone forward. Genioplasty was useful in patients with congenital anomalies who had a recurrence of sleep apnea after several procedures.

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“…A mild form of this disorder is usually considered as a harmless developmental anomaly of the face, while a severe form may seriously affect the health. The complications of a severe midface hypoplasia may include breathing problems while sleeping (sleep apnea), misalignment of the jaw and eyelids, dental malocclusion, chewing and swallowing difficulties, and overall disfigurement of the face (Cielo & Marcus, 2015;Hall & Precious, 2013;Patel & Fearon, 2015). Apart from the psychological burden, the patients may have insomnia, high blood pressure, persistent dry eyes, and speech and chewing difficulties (Patel & Fearon, 2015).…”

Section: Midface Hypoplasiamentioning

confidence: 99%

Role of Matrix Gla protein in midface development: Recent advances

Marulanda

Murshed

2018

Oral Diseases

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Craniofacial development is a delicate process that involves complex interactions among cells of multiple developmental origins, their migration, proliferation, and differentiation. Tissue morphogenesis of the craniofacial skeleton depends on genetic and environmental factors, and on specific signaling pathways, which are still not well understood. Developmental defects of the midface caused by the absence, delays, or premature fusion of nasal and maxillary prominences vary in severity; leading to clefts, hypoplasias, and midline expansion. In the current review, we focus on the importance of the chondrocranium in craniofacial growth and how its impaired development leads to midface hypoplasia. More importantly, we reported how Matrix Gla protein (MGP), a potent inhibitor of extracellular matrix mineralization, facilitates midface development by preventing ectopic calcification of the nasal septum. In fact, MGP may act as a common link in multiple developmental pathologies all showing midface hypoplasia caused by abnormal cartilage calcification. This brief review discusses the gap in knowledge in the field, raises pertinent questions, which remain unanswered, and sheds light on the future research directions.

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Treatment of the Syndromic Midface

Cited by 38 publications

References 15 publications

Monobloc Differential Distraction Osteogenesis

Monobloc Differential Distraction Osteogenesis

Useful Genioplasty for Repeated Recurrent Sleep Apnea of Congenital Anomalies and Its Evaluation

Role of Matrix Gla protein in midface development: Recent advances

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