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Spazzapan P, Velnar T. Isolated Sagittal Craniosynostosis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:435. [PMID: 38396475 PMCID: PMC10887665 DOI: 10.3390/diagnostics14040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options.
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Affiliation(s)
- Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Alma Mater Europaea ECM, 2000 Maribor, Slovenia
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Haber SE, Leikola J, Nowinski D, Fauroux B, Morisseau-Durand MP, Paternoster G, Khonsari RH, Arnaud E. Secondary Le Fort III after Early Fronto-Facial Monobloc Normalizes Sleep Apnea in Faciocraniosynostosis: A Cohort Study. J Plast Reconstr Aesthet Surg 2022; 75:2706-2718. [PMID: 35431130 DOI: 10.1016/j.bjps.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 07/26/2021] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aims to assess the improvement of sleep apnea after secondary Le Fort III facial advancement with distraction (LF3) in faciocraniosynostosis (FCS) patients with sleep apnea who have previously undergone fronto-facial monobloc advancement (FFMBA) with distraction. METHODS Patients having undergone secondary LF3 were selected from a cohort of FCS patients with documented sleep apnea who had previously undergone fronto-facial monobloc advancement. Patient charts and polysomnographic records were reviewed. Apnea-hypopnea index (AHI) was recorded before and at least 6 months after secondary LF3. The primary outcome was normalization of AHI (less than 5/h was considered normal). Hierarchical multilevel analysis was performed to predict postoperative AHI evolution. RESULTS Seventeen patients underwent a secondary LF3, 7.0 ± 3.9 years after the primary FFMBA. The mean age was 9.6 ± 3.9 years. A total of 15 patients (88%) normalized their AHI. Two of four patients were decannulated (50%). There was a statistically significant decrease in AHI (preoperative AHI 21.5/h vs. 3.9/h postoperatively, p=0.003). Hierarchic multilevel modeling showed progressive AHI decrease postoperatively. CONCLUSION Secondary LF3 improves residual or relapsing sleep apnea in FCS patients who have previously had FFMBA.
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Affiliation(s)
- Samer E Haber
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université de Paris; Paris, France
| | - Junnu Leikola
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Töölö Hospital, Helsinki University Central Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
| | - Daniel Nowinski
- Department of Surgical Sciences, Uppsala University, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Brigitte Fauroux
- Service de Ventilation Non-Invasive et Sommeil de l'Enfant; Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; EA7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique); Université Paris-Descartes, Université Sorbonne Paris Cité; Paris, France
| | - Marie-Paule Morisseau-Durand
- Service d'Otorhinolaryngologie pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Centre de Référence Maladies Rares MALO, Filière Maladies Rares TeteCou; Université de Paris, Université Paris Descartes; Paris, France
| | - Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université de Paris; Paris, France
| | - Roman H Khonsari
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou; Université de Paris, Université de Paris; Paris, France
| | - Eric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université de Paris; Paris, France; Clinique Marcel Sembat, Ramsay Générale de Santé, 92100 Boulogne, France.
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Calluaud G, Pare A, Kulker D, Listrat A, Laure B. Computer-assisted fronto-facial monobloc advancement and facial bipartition for Pfeiffer's Syndrome: the surgical technique. World Neurosurg 2022; 161:97-102. [PMID: 35176524 DOI: 10.1016/j.wneu.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In the Pfeiffer syndrome, several corrections are required to correct the facial retrusion, the maxillary deficiency or even the hypertelorism. The fronto-facial monobloc advancement (FFMA) and the facial bipartition (FB) are the gold standard surgeries. We present the correction of this deformity using a simultaneous computer-assisted FFMA and FB. TECHNICAL NOTE The 3D surgical planning defined the virtual correction and the bone cutting guide in view of the FFMA and the FB. Coronal and intraoral approaches were combined to perform the osteotomies. Four internal distractors were also placed for the postoperative distraction osteogenesis. DISCUSSION Computer-assisted surgery is helpful and a reliable option for the management of complex facio-craniosynostosis such as hypertelorism and fronto-facial retrusion.
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Affiliation(s)
- Gauthier Calluaud
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France; University of François Rabelais, School of Medicine, Tours, France
| | - Arnaud Pare
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France; Reference Center for rare Craniostenose and Craniofacial Malformations (CRANIOST); University of François Rabelais, School of Medicine, Tours, France
| | - Dimitri Kulker
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France; University of François Rabelais, School of Medicine, Tours, France
| | - Antoine Listrat
- Department of Maxillofacial Surgery and Neurosurgery, Clocheville Hospital, University Hospital Center of Tours, Tours, France; Reference Center for rare Craniostenose and Craniofacial Malformations (CRANIOST)
| | - Boris Laure
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France; Reference Center for rare Craniostenose and Craniofacial Malformations (CRANIOST); University of François Rabelais, School of Medicine, Tours, France.
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Kamata M, Sakamoto Y, Miwa T, Toda M, Kishi K. Posterior distraction with shell: modifications to prevent gull-wing deformity in craniosynostosis. J Plast Reconstr Aesthet Surg 2022; 75:1497-1520. [DOI: 10.1016/j.bjps.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
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Paternoster G, Haber SE, Khonsari RH, James S, Arnaud E. Craniosynostosis: Monobloc Distraction with Internal Device and Its Variant for Infants with Severe Syndromic Craniosynostosis. Clin Plast Surg 2021; 48:497-506. [PMID: 34051901 DOI: 10.1016/j.cps.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of distraction osteogenesis to frontofacial monobloc advancement has increased the safety of the procedure. One hundred forty-seven patients with syndromic craniosynostosis underwent frontofacial monobloc advancement using 4 internal distractors. Twenty-five were aged 18 months or less. Ten patients presented with a tracheostomy, 5 (50%) were decannulated after surgery, and 3 others (30%) required an additional intervention before decannulation. Six patients required the addition of a transfacial pin and external traction. Very early frontofacial monobloc with 4 internal distractors is a safe and effective treatment to protect the ophthalmic, neurologic, and respiratory functions in infants with severe syndromic craniosynostosis.
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Affiliation(s)
- Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France
| | - Samer Elie Haber
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France
| | - Roman Hossein Khonsari
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université de Paris, Université Paris Descartes, 149 rue de Sèvres, 75015, Paris, France
| | - Syril James
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Clinique Marcel Sembat, Ramsay Générale de Santé, 105 boulevard Victor Hugo, 92100 Boulogne, France
| | - Eric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Clinique Marcel Sembat, Ramsay Générale de Santé, 105 boulevard Victor Hugo, 92100 Boulogne, France.
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Abstract
INTRODUCTION Craniosynostosis is characterized by the fusion of 1 or more sutures of the skull leading to craniofacial deformations. Our aim is to describe the dental malocclusion associated with craniosynostosis, syndromic, or nonsyndromic, and also the treatment used and its stability. MATERIAL AND METHODS This retrospective study included all patients who presented at our Department for facial growth monitoring and occlusal management following syndromic and nonsyndromic craniosynostosis. Inclusion began in January 1996 and ended in December 2015 to ensure sufficient follow-up. Orthognathic surgery was performed after the end of growth. Dental occlusion was evaluated clinically and radiographically. RESULTS Fifty-five patients were included with 18 syndromic cases. The majority of patients presented with class III malocclusion (69.1%), especially syndromic cases (94.7%) and brachycephalies (96.3%). Conversely, scaphocephalies are associated with class II malocclusions. Thirty-nine patients underwent orthodontic treatment associated with orthognathic surgery to correct their malocclusion. In 4 cases, optimal dental occlusion was achieved with orthodontic treatment alone. Forty patients achieved stable optimal final dental occlusion. Optimal dental occlusion was achieved in 76.9% of the nonsurgically treated craniosynostosis patients and 68.9% of the surgically treated craniosynostosis patients. DISCUSSION Sutural fusion induces a facial growth restrictions and dental malocclusions. Several mechanisms may be responsible for these malocclusions: positional anomaly of the jaws due to the cranial deformity, associated anomaly of the facial sutures, or osteocartilagenous system diseases. Early craniosynostosis management does not avoid the occurrence of malocclusion, which will require orthodontic treatment and orthognathic surgery for their management.
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Excessive ossification of the bandeau in Crouzon and Apert syndromes. J Craniomaxillofac Surg 2020; 48:376-382. [DOI: 10.1016/j.jcms.2020.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
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Raposo-Amaral CE, Denadai R, Máximo G, Raposo-Amaral CA, Ghizoni E. Pfeiffer Syndrome: A Therapeutic Algorithm Based on a Modified Grading Scale. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2788. [PMID: 32440448 PMCID: PMC7209848 DOI: 10.1097/gox.0000000000002788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pfeiffer syndrome (PS) is a very rare condition with a wide clinical spectrum. There are only a few studies that address the classification and treatment of PS and take into account the most commonly presented clinical features. Thus, the objectives of this study are to propose an algorithm for PS management based on a modified severity scale and correlate PS severity with tracheostomy placement. METHODS An observational retrospective study was performed on consecutive patients with PS (n = 12), who underwent surgery between 2008 and 2018. Clinical features and findings of all included patients with PS were classified as types A, B, and C, which guided treatment workflow. The Fisher test was used to correlate the severity of patients with PS with tracheostomy placement. RESULTS There were 12 patients, classified as type A (n = 3), type B (n = 6), and type C (n = 3). All patients who received tracheostomies (n = 6) were stratified into the severe category (n = 9; types B and C) (P < 0.05). There were 4 minor complications, and 1 major complication according to a modified Clavien-Dindo surgical complication scale. CONCLUSION A treatment algorithm based on the 3 different Pfeiffer types was proposed. Severity of PS statistically correlates to tracheostomy placement.
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Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Rafael Denadai
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Geiza Máximo
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Enrico Ghizoni
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
- Department of Neurology, University of Campinas (UNICAMP), São Paulo, Brazil
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仇 书, 刘 大, 钟 建. [Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:97-100. [PMID: 32086910 PMCID: PMC10128403 DOI: 10.13201/j.issn.1001-1781.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 06/10/2023]
Abstract
The French Society of ENT and Head Neck Surgery(SFORL)present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018,this paper is the interpretation of the guidelines.
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Affiliation(s)
- 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Otolaryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
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Khonsari RH, Paternoster G. International Society of Craniofacial Surgery, XVIIIth biennal meeting in Paris: A report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:102-104. [PMID: 31672682 DOI: 10.1016/j.jormas.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- R H Khonsari
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TETECOU, Université Paris - Descartes, Université de Paris, Paris, France
| | - G Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TETECOU, Université Paris - Descartes, Université de Paris, Paris, France
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Joly A, Croise B, Travers N, Listrat A, Pare A, Laure B. Management of isolated and complex craniosynostosis residual deformities: What are the maxillofacial tools? Neurochirurgie 2019; 65:295-301. [DOI: 10.1016/j.neuchi.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
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Couloigner V, Ayari Khalfallah S. Craniosynostosis and ENT. Neurochirurgie 2019; 65:318-321. [DOI: 10.1016/j.neuchi.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Defining Critical Ages for Orbital Shape Changes after Frontofacial Advancement in Crouzon Syndrome. Plast Reconstr Surg 2019; 144:841e-852e. [DOI: 10.1097/prs.0000000000006162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chirurgie secondaire des craniosténoses et faciocraniosténoses. ANN CHIR PLAST ESTH 2019; 64:494-505. [DOI: 10.1016/j.anplas.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
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Posterior Distraction First or Fronto-Orbital Advancement First for Severe Syndromic Craniosynostosis. J Craniofac Surg 2019; 30:47-49. [PMID: 30418288 DOI: 10.1097/scs.0000000000004897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Posterior calvarial vault expansion using distraction osteogenesis is performed for syndromic craniosynostosis as the first choice. This procedure allows far greater intracranial volume than fronto-orbital advancement (FOA). This study aimed to determine the most suitable timing of posterior distraction or FOA to sufficiently increase the intracranial volume and remodel the skull shape. PATIENTS AND METHODS From 2014 to 2017, the authors performed posterior distraction in 13 patients with syndromic craniosynostosis. Data on premature suture fusion, age at first visit, age at surgery, skull thickness, and complications were collected. RESULTS Five patients underwent posterior distraction at approximately 12 months of age and had no complications, including cerebrospinal fluid leakage or gull wing deformity. However, during the waiting period for the operation, the skull deformity continues to extend upward (turribrachycephaly). To prevent progress of the skull deformity, the authors performed the operation at approximately 6 months of age in 7 patients. However, in 3 of 7 patients whose lambdoid sutures were opening, gull wing deformity occurred. From these results, in a patient with severe Beare-Stevenson syndrome, the authors performed FOA first at 5 months of age, followed by posterior distraction at 12 months of age, and achieved favorable results. CONCLUSIONS Treatment patterns are patient specific and should be tailored to premature suture fusion, specific skull deformity, and required intracranial volume of each patient.
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Mandibular symphyseal distraction osteogenesis: 20 years of experience treating transverse deficiencies with an internal hybrid device. J Craniomaxillofac Surg 2019; 47:586-591. [PMID: 30718215 DOI: 10.1016/j.jcms.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/04/2018] [Accepted: 01/04/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Transverse mandibular deficiency has been traditionally managed by orthodontic compensation. However, without resolving the underlying skeletal hypoplasia it leads to high relapse rates. Few studies have reviewed the long-term experience and potential complications of mandibular symphyseal distraction osteogenesis (MSDO) as an alternative treatment method. MATERIALS AND METHOD A retrospective review of 20 patients (range: 4-19 years; mean: 11.9 years) treated with a hybrid MSDO device over the period of 1996-2017 was conducted. Epidemiological data, medical and dental history as well as photographic and cephalometric analyses were carried out. Furthermore, pre-operative and long-term post-operative status including dental occlusion and tooth-jaw discrepancies were recorded. RESULTS The distraction amount ranged from 3 mm to 15 mm (mean: 10 mm) with an average distraction period of 30.9 days. In long-term follow-up (mean: 7.3 years), 14 patients presented a class I and 6 patients presented a class II relationship. Correction of overjet, tooth jaw discrepancy and arch length discrepancy were obtained in 18, 20 and 17 cases respectively. A device malfunction was experienced in 6 patients. CONCLUSION Mandibular widening using a hybrid MSDO device can be efficiently and safely performed in a paediatric population. Further studies confirming our results and analysing facial aesthetic outcomes are warranted.
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Sicard L, Hounkpevi M, Tomat C, James S, Paternoster G, Khonsari RH, Arnaud E. Dental consequences of pterygomaxillary dysjunction during fronto-facial monobloc advancement with internal distraction for Crouzon syndrome. J Craniomaxillofac Surg 2018; 46:1476-1479. [DOI: 10.1016/j.jcms.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022] Open
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A genotype-specific surgical approach for patients with Pfeiffer syndrome due to W290C pathogenic variant in FGFR2 is associated with improved developmental outcomes and reduced mortality. Genet Med 2018; 21:471-476. [DOI: 10.1038/s41436-018-0073-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
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Pateron B, Marianowski R, Monteyrol PJ, Couloigner V, Akkari M, Chalumeau F, Fayoux P, Leboulanger N, Franco P, Mondain M. French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:265-268. [PMID: 29731297 DOI: 10.1016/j.anorl.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The authors present the guidelines of the French Society of ENT and Head & Neck Surgery (SFORL) on the role of the ENT physician in childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). This section of the guidelines concerns the roles of the various medical and surgical treatment options. METHOD A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Based on the retrieved articles and the group members' own experience, guidelines were drawn up, then read over by a reading group independent of the work-group. An editorial meeting then produced the final text. RESULTS Adenotonsillectomy is the reference treatment for childhood OSAHS with adenotonsillar hypertrophy. Respiratory assistance is recommended in children with severe OSAHS without nasal and/or oropharyngeal obstacle, after surgery in case of persistent OSAHS, in case of contraindications to surgery, in complex obstruction related to pharyngolaryngeal or laryngeal pathology or comorbidity, or as an alternative to tracheotomy. Nasal route corticosteroids may be used in childhood OSAHS in with associated nasal obstruction.
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Affiliation(s)
- B Pateron
- Service de chirurgie ORL et cervico-faciale, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
| | - R Marianowski
- Service de chirurgie ORL et cervico-faciale, CHU de Brest, 29000 Brest, France
| | | | - V Couloigner
- Service de chirurgie ORL et cervico-faciale, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - M Akkari
- Service de chirurgie ORL et cervico-faciale, 34000 Montpellier, France
| | | | - P Fayoux
- Service de chirurgie ORL et cervico-faciale, CHRU de Lille, 59037 Lille cedex, France
| | - N Leboulanger
- Service de chirurgie ORL et cervico-faciale, hôpital universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - P Franco
- Cabinet de pédiatrie, 69500 Lyon, France
| | - M Mondain
- Service de chirurgie ORL et cervico-faciale, 34000 Montpellier, France
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Mastouri M, Amaddeo A, Griffon L, Frapin A, Touil S, Ramirez A, Khirani S, Fauroux B. Weaning from long term continuous positive airway pressure or noninvasive ventilation in children. Pediatr Pulmonol 2017; 52:1349-1354. [PMID: 28714612 DOI: 10.1002/ppul.23767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES A significant number of children are able to discontinue long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) but the underlying disorders, weaning criteria, and outcome of these children have not been studied. STUDY DESIGN Retrospective cohort follow up. SUBJECT SELECTION Consecutive children who were weaned from long term CPAP/NIV between October 2013 and January 2016. METHODOLOGY Underlying disorders, weaning criteria, and clinical outcome were analyzed. RESULTS Fifty eight (27%) of the 213 patients on long term CPAP/NIV could be weaned from CPAP/NIV with 50 patients being weaned from CPAP and 8 from NIV. Most patients were young children with upper airway anomalies, Prader Willi syndrome or bronchopulmonary dysplasia. CPAP/NIV was discontinued following spontaneous improvement of sleep-disordered breathing in 33 (57%) patients, upper airway surgery (n = 14, 24%), maxillofacial surgery (n = 6, 11%), neurosurgery (n = 1, 2%), upper airway and neurosurgery (n = 2, 3%), or switch to oxygen therapy (n = 2, 3%). CPAP/NIV was discontinued due to normal nocturnal gas exchange during spontaneous breathing in all patients, with an obstructive apnea-hypopnea index ≤6 events/h on a combined poly(somno)graphy in 27 patients. A relapse of obstructive sleep apnea was observed after a median delay of 2 years in six patients who resumed CPAP and in one patient who underwent midface distraction. CONCLUSIONS Weaning from CPAP/NIV is possible in children treated with long term CPAP/NIV but is highly dependent on the underlying disorder. Spontaneous improvement is possible but most children need specific surgery. Long term follow-up is necessary in children with underlying disorders.
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Affiliation(s)
- Meriem Mastouri
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Department of Pediatrics, CHR Citadelle, ULG University, Liege, Belgium
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Paris Descartes University, Paris, France.,Research Unit INSERM U 955, team 13, Créteil, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Annick Frapin
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Samira Touil
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Adriana Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Air Liquide European Homecare Operations Services (ALEHOS), Gentilly, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Air Liquide European Homecare Operations Services (ALEHOS), Gentilly, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Paris Descartes University, Paris, France.,Research Unit INSERM U 955, team 13, Créteil, France
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