Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: Correlation between volume changes and respiratory outcome

Treatment of the Syndromic Midface

“…[11][12][13][14] It has been suggested that, for some patients, a greater vertical component to the advancement may be more beneficial, and others believe that Le Fort III advancements may be more efficacious in improving ventilation than the monobloc advancements. 13,15 Spontaneous improvements in syndromic craniosynostosisassociated obstructive sleep apnea in the first 3 years of life have been reported, and it has been further suggested that apnea does not worsen with growth; however, our findings appear to contradict these observations. 16 We found that although rigid external distraction Le Fort III advancements effectively eliminated obstructive sleep apnea in most patients, ventilatory degradation was observed over time in 10 percent (30 percent among those with prior documented impaired ventilation) with either recurrent, or de novo, obstructive sleep apnea despite a postoperatively stable maxilla.…”

Craniofacial syndromes and sleep-related breathing disorders

“…The specified preference is to perform midface advancement (monobloc or Le Fort III) in adulthood, unless there is an earlier clinical indication such as severe OSA and/or exorbitism. The majority of patients who undergo midface advancement (Le Fort I or III) show evidence of respiratory improvements, as determined by sleep study results in conjunction with clinical evaluation of the patient (35). Upper airway volume has been shown to increase following the surgical procedure (36).…”

Experimental and clinical assessment of three-dimensional cephalometry: A systematic review

“…The establishment of a universal list of repeatable landmarks could help to determine and evaluate linear, angular and proportional measurements. This list could also enable the inclusion of volumetric and surface measurements in 3D cephalometry, which could be helpful in airway or orbital volume analysis for syndromic or post-injury deformities (Imai et al, 2013;Kwon et al, 2009;Nout et al, 2012), as well as in soft tissue surface analysis for orthognathic surgery (Meller et al, 2005;Xia et al, 2000). The theoretical considerations could further include a combination of 3D cephalometry and finite element analysis, which could allow for more accurate prediction of the effects of surgical distraction or orthodontic expansion (Araugio et al, 2013;Remmler et al, 1998).…”