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Meazzini MC, Piza A, Giorgio N, Sozzi D, de Ponti E, Mazzoleni F. Long-term mandibular growth in patients with airway obstruction treated with mandibular distraction. J Craniomaxillofac Surg 2024; 52:792-797. [PMID: 38644093 DOI: 10.1016/j.jcms.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/30/2024] [Indexed: 04/23/2024] Open
Abstract
Congenital craniofacial malformations play an important role in upper airway obstruction. One of the main causes is mandibular hypoplasia which is present in the pierre robin sequence. Mandibular distraction osteogenesis (MDO) is one of the most commonly used treatments for the resolution of upper airway obstruction in patients that do not respond to a conservative treatment. We performed a long term follow up of syndromic and non-syndromic patients with pierre robin sequence where the lateral xrays were studied before surgery (T1), after MDO (T2) and long-term follow-up (T3, at least 5 years). Possible complications of the surgery were also studied through panoramic x-rays and clinical controls. The results evidenced an increase of mandibular length comparing T1-T2 and a good stability during the long-term follow-up. The Sd patients presented smaller mandible dimensions. We had not found any complications during the follow-up. The scars outcomes are modest, but none of the patients requested a surgical correction. Mandibular distraction osteogenesis is a treatment to be considered in patients with upper airway obstruction that do not respond to conservative treatments. The results of the surgery are stable and the complications in experienced hands are low.
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Affiliation(s)
- Maria Costanza Meazzini
- Department of Maxillofacial Surgery, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alejandro Piza
- Department of Maxillofacial Surgery, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Novelli Giorgio
- Department of Maxillofacial Surgery, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Davide Sozzi
- Department of Maxillofacial Surgery, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Elena de Ponti
- Department of Medical Physics, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Mazzoleni
- Department of Maxillofacial Surgery, University of Milano-Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
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Abourjeili J, Salameh E, Noureddine M, Bou Khalil P, Eid AA. Obstructive sleep apnea: Beyond the dogma of obesity! Respir Med 2024; 222:107512. [PMID: 38158138 DOI: 10.1016/j.rmed.2023.107512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Obstructive sleep apnea (OSA) has long been studied in patients with obesity and type 2 diabetes mellitus (T2DM), due to the fact that both disorders are commonly associated with an increased body mass index (BMI). However, a link between OSA and non-obese diabetic patients is still not very elaborated, nor heavily explored. In this review, we elucidate some proposed mechanisms for the link between OSA and diabetic patients both with and beyond obesity, shedding the light on the latter case. One such mechanism is oxidative stress, a phenomenon of reactive oxygen species (ROS) imbalance seen in both of the previously mentioned disorders. A plausible explanation for the OSA-induced ROS production is the repeating episodes of hypoxia and reperfusion and their effect on the mitochondrial electron transport chain. This paper explores the literature regarding ROS imbalance as the possible missing link between OSA and Diabetes Mellitus beyond obesity, while still mentioning other possible proposed mechanisms such as a dysregulated autonomic nervous system (ANS), as well as mechanical and craniofacial abnormalities. This paper also suggests a link between OSA and diabetic complications, while exploring the clinical progress made in treating the former disorder with anti-oxidant and hypo-glycemic drugs. If further investigated, these findings could help identify novel therapeutic interventions for the treatment of OSA and Diabetic patients.
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Affiliation(s)
- Joseph Abourjeili
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Elio Salameh
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Maya Noureddine
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Pierre Bou Khalil
- Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Assaad A Eid
- Department of Anatomy, Cell Biology, And Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon; AUB Diabetes, American University of Beirut, Faculty of Medicine, Medical Center, Lebanon.
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3
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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顾 伟, 樊 悦, 霍 红, 陈 晓. [Obstructive sleep apnea in microtia children with maxillofacial dysostosis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:371-379. [PMID: 33794641 PMCID: PMC10128449 DOI: 10.13201/j.issn.2096-7993.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 06/12/2023]
Abstract
Children with microtia are often associated with maxillofacial dysostosis, such as Treacher Collins syndrome, Goldenhar syndrome, and Nager syndrome, and they are prone to suffer from obstructive sleep apnea(OSA). Obstruction widely occurred in the upper airway is the main mechanism of OSA in these children, and dysplasia of the pharynx and neurodevelopmental abnormalities may also participate. Early diagnosis requires symptom screening and polysomnography. Imaging techniques and endoscopy can be adopted to fully assess the upper airway status to guide further treatment. According to the child's condition and the main obstruction site, treatment methods include maxillofacial deformity correction, continuous positive pressure ventilation and tracheotomy. OSA in microtia children with maxillofacial dysostosis needs to be identified and treated in time to reduce the adverse effects on the growth and development of children.
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Affiliation(s)
- 伟 顾
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 悦 樊
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 红 霍
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 晓巍 陈
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
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Lu X, Forte AJ, Park KE, Allam O, Smetona J, Alperovich M, Steinbacher DM, Tonello C, Alonso N, Persing JA. Airway Growth in Preoperative Patients with Crouzon Syndrome. Facial Plast Surg Aesthet Med 2021; 23:191-197. [PMID: 33577380 DOI: 10.1089/fpsam.2020.0441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Obstructive sleep apnea is common in patients with Crouzon syndrome, yet it may be caused by multiple factors. This study aims to investigate the natural history of airway development in preoperative Crouzon patients, from infants to adults. Methods: Preoperative computed tomography (CT) scans (Crouzon syndrome, n = 73; control, n = 87) were divided into five age subgroups. CT scans were measured using Materialise software. Results: Before 6 months of age, nasal airway volume in patients with Crouzon syndrome was smaller than normal by 37% (p = 0.002), and the cross-sectional area at the choana reduced by 45% (p < 0.001). The reduction of nasal airway volume and cross-sectional area reached their nadir at 2 years of age, with shortening of 44% and 63% (both p < 0.001), respectively. They gradually caught up to normal dimensions after 6 years of age. Between 2 and 6 years, the pharyngeal airway in patients with Crouzon syndrome reduced 44% (p = 0.011) compared with controls. However, the airway cross-sectional area at condylion and gonion levels was less than normal, before 6 months (35%, p = 0.024) and (44%, p = 0.006) after 2 years of age, respectively. This reduction remains into adulthood. Conclusion: Nasal airway volume is more limited in children with Crouzon syndrome who are younger than 2 years of age. Whereas after 2 years of age, the pharyngeal airway develops significant volume restriction, leading to timing and specific treatment area foci based on the site of temporal maximal constriction.
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Affiliation(s)
- Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Antonio Jorge Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Kitae Eric Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Omar Allam
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - John Smetona
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Derek M Steinbacher
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cristiano Tonello
- Department of Craniofacial Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil
| | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - John A Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Alloplastic Temporomandibular Joint Reconstruction in Congenital Craniofacial Deformities. J Craniofac Surg 2021; 32:e548-e551. [PMID: 34081423 DOI: 10.1097/scs.0000000000007533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Temporomandibular joint (TMJ) reconstruction with alloplastic prosthesis is a commonly performed procedure, which can be used as a treatment for improving pathologic conditions affecting the TMJ. Depending of the severity of the condition, the patient's ability to eat can be impaired, which in turn can affect their quality of life. Several syndromes can affect the patient's facial features, and some of those also affect TMJ's. Use of alloplastic prosthesis in TMJ's affecting syndromes, by means of correcting TMJ conditions and mandibular deformities, is still rather uncommon. Purpose of our study is to review the use TMJ total prosthesis as a treatment modality for correcting TMJ conditions and the reconstruction of mandibular deformities in congenital syndromes affecting the facial features. This study consists of a retrospective cohort of patients treated with TMJ reconstruction with alloplastic prosthesis at the Helsinki University Hospital during the past decade. All subjects with congenital syndrome who underwent TMJ reconstruction were included the study. The cohort consisted of seven patients and ten joints treated. Temporomandibular joints affecting syndromes were Goldenhar syndrome, hemifacial macrosomia, Nager syndrome, and Treacher-Collins syndrome. The majority of the patients have had several previous operative treatments on the facial skeleton during their childhood, which in turn probably affected and compromised the TMJ surgery outcome. Mouth opening was sufficiently achieved as average maximal opening was 34 mm (range 24-42 mm) postoperatively. Temporomandibular joint reconstruction with alloplastic prosthesis can offer new tools and approaches for treatment of facial deformities in syndromes with craniofacial abnormalities. Impaired jaw functions and asymmetry can be addressed with the use of alloplastic prostheses, achieving sufficient mouth opening and restoring the symmetry of the lower facial skeleton.
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Mehta B, Waters K, Fitzgerald D, Badawi N. Survey of the practices of neonatologists in managing neonates believed to be at high risk of sleep disordered breathing. BMJ Paediatr Open 2021; 5:e000979. [PMID: 33681476 PMCID: PMC7898842 DOI: 10.1136/bmjpo-2020-000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the practices of neonatologists in managing high-risk neonates believed to be at risk of sleep disordered breathing (SDB). DESIGN An electronic web-based questionnaire assessing awareness of and current practices for managing neonates predisposed to SDB with conditions like craniofacial anomalies, neuromuscular disorders or airway problems was emailed to 232 neonatologists and neonatal fellows working in Australia and New Zealand (NZ). Additionally, neonatologists were approached directly during the annual Australia and NZ perinatal conference in 2019. RESULTS 93 neonatologists (40%) responded to the survey. The majority (85%) of the respondents stated that there were no written protocols/criteria for sleep consultation in their unit. We found considerable variations in the threshold for performing tests including oximetry or referring for polysomnography. Most respondents would perform oximetry before referring for a sleep consultation. However, the duration of oximetry varied from 6 to 24 hours and there was no consensus about what is considered abnormal on an oximetry study. CONCLUSION Management of SDB is gaining importance in neonatal care because of prolonged length of hospital stay and possible long-term effects of SDB. Responses received suggest a lack of clarity regarding thresholds for referral for treatment of SDB. Likely contributory factors are concerns regarding a lack of long-term outcome data from treatment perceived to be onerous for the family, unsettling to some infants and delaying hospital discharge. To overcome inconsistencies in practice, standardised guidelines for assessing and managing SDB in neonates are needed.
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Affiliation(s)
- Bhavesh Mehta
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Karen Waters
- Sleep Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dominic Fitzgerald
- Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nadia Badawi
- Neonatology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Sleep-Disordered Breathing and Airway Assessment Using Polysomnography in Pediatric Patients With Craniofacial Disorders. J Craniofac Surg 2020; 31:720-726. [PMID: 32049904 DOI: 10.1097/scs.0000000000006249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children with cleft and craniofacial conditions commonly present with concurrent airway anomalies, which often manifest as sleep disordered breathing. Craniofacial surgeons and members of the multidisciplinary team involved in the care of these patients should appreciate and understand the scope of airway pathology as well as the proper means of airway assessment. This review article details the prevalence and assessment of sleep disordered breathing in patients with craniofacial anomalies, with emphasis on indications, limitations, and interpretation of polysomnography.
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Klazen YP, Caron CJ, Schaal SC, Borghi A, Van der Schroeff MP, Dunaway DJ, Padwa BL, Koudstaal MJ. What Are the Characteristics of the Upper Airway in Patients With Craniofacial Microsomia? J Oral Maxillofac Surg 2019; 77:1869-1881. [DOI: 10.1016/j.joms.2019.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
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10
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Eliason MJ, Melzer JM, Gallagher TQ. Cornelia de Lange syndrome: What every otolaryngologist should know. EAR, NOSE & THROAT JOURNAL 2018; 96:E6-E9. [PMID: 28846791 DOI: 10.1177/014556131709600802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cornelia de Lange Syndrome (CdLS) can be expressed in multiple organ systems requiring a variety of specialists, including pediatric otolaryngology. We present the case of a 20-month-old boy with CdLS actively managed by an aerodigestive team consisting of pediatric otolaryngology, pediatric pulmonology, pediatric gastroenterology, with support staff from audiology, speech, and nutrition. His presentation included mixed hearing loss, dysphagia, microaspiration, gastroesophageal reflux, and failure to thrive. We submit this challenging case of CdLS with a review of the literature to focus specific attention on the otolaryngic manifestations of the syndrome and to discuss the benefits of a multidisciplinary approach to these unique patients.
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Affiliation(s)
- Michael J Eliason
- Department of Otolaryngology, Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
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Cronjé L. Bardet–Biedl syndrome: expect the unexpected, suspect the unsuspected. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1379719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Larissa Cronjé
- Perioperative Research Group, Department of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
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Abstract
BACKGROUND Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques. DATA SOURCES Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia. RESULTS The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed. CONCLUSIONS Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
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Abstract
A retrospective cohort study was set up to analyse the prevalence and treatment of obstructive sleep apnoea (OSA) in relation to the severity of the deformity in patients with craniofacial microsomia (CFM). This study included a population of 755 patients with CFM from three craniofacial centres. Medical charts were reviewed for severity of the deformity, types of breathing difficulty, age at which breathing difficulty first presented, treatment for OSA, and treatment outcome. In total, 133 patients (17.6%) were diagnosed with OSA. Patients with Pruzansky IIB/III classification or bilateral craniofacial microsomia were significantly more often diagnosed with OSA than unilaterally affected patients of Pruzansky I/IIA classification. The initial treatment of OSA consisted of adenotonsillectomy, tracheotomy, or non-invasive positive pressure ventilation. Thirty-seven patients received more than one treatment (range 1-3). In this study, the prevalence of OSA in patients with CFM was higher than the prevalence in the healthy population described in the literature. Although several treatment modalities are available for the treatment of OSA in patients with CFM, treatment should be individualized and based on clinical symptoms, the severity of the deformity, and comorbidities.
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Abstract
Screening for obstructive sleep apnea (OSA) with in-laboratory polysomnography is recommended for children with sleep disordered breathing. Adenotonsillectomy is the first-line therapy for pediatric OSA, although intranasal steroids and montelukast can be considered for those with mild OSA and continuous positive airway pressure for those with moderate to severe OSA awaiting surgery, poor surgical candidates or persistent OSA. Bony or soft tissue upper airway surgery is reasonable for children failing medical management or those with persistent OSA following adenotonsillectomy. Weight loss and oral appliance therapy are also useful. A multi-modality approach to diagnosis and treatment is preferred.
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Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2021, Cincinnati, OH 45229, USA
| | - Stacey L Ishman
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2021, Cincinnati, OH 45229, USA; Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA; University of Cincinnati School of Medicine, Department of Otolaryngology - Head & Neck Surgery, 231 Albert Sabin Way, MSB 6503, Cincinnati, Ohio 45267-0528, USA.
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Efficacy of Standard Costochondral Grafting in Patients With Bilateral Craniofacial Microsomia. J Craniofac Surg 2016; 27:e673-e676. [PMID: 27617809 DOI: 10.1097/scs.0000000000003075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniofacial microsomia remains the second most common craniofacial deformity after cleft lip and palate. Mandibular pathology has been classically scored from type I to type III by the modified Pruzansky-Kaban classification. The authors report a case of a 5-year-old patient with Goldenhar syndrome and bilateral type III craniofacial macrosomia. The patient had absence of bilateral glenoid fossas, condyles, coronoids, and rami as well as hypoplasia of the symphysis, parasymphysis, and mandibular body. Reconstruction was performed using 2 costochondral rib autografts to reconstruct a ramus and assist in the development of a neo-glenoid fossa at the cranial base. An additional portion of costal rib graft was used to augment the deficient symphysis. The patient was placed in class III occlusion postoperatively using maxillo-mandibular fixation screws and heavy elastics. The bone grafts healed without complications with no evidence of ankylosis, nonunion, or resorption to date. For the most severe forms of craniofacial microsomia, costochondral grafting remains an effective initial technique for lengthening the hypoplastic mandible and providing a foundation for future distraction.
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Treacher Collins Syndrome: A Systematic Review of Evidence-Based Treatment and Recommendations. Plast Reconstr Surg 2016; 137:191-204. [PMID: 26710023 DOI: 10.1097/prs.0000000000001896] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No reviews or guidelines are available on evidence-based treatment for the multidisciplinary approach in Treacher Collins syndrome. The authors' aim is to provide an evidence-based review of multidisciplinary treatment of Treacher Collins syndrome based on levels of evidence and supported with graded recommendations. METHODS A systematic search was performed by means of the PubMed, Web-of-Science, Embase, and Cochrane Central databases (1985 to January of 2014). Included were clinical studies (with five or more Treacher Collins syndrome patients) related to therapy, diagnosis, or risk of concomitant diseases. Level of evidence of the selected articles was rated according to the American Society of Plastic Surgeons evidence-based clinical practice guidelines. After two panelists had reviewed each abstract separately, a consensus method was used to solve any disagreements concerning article inclusion. RESULTS Of the 2433 identified articles, 63 studies (Level of Evidence II through V) were included. Conclusions and recommendations were extracted consecutively for the following items: upper airway; ear, hearing, and speech; the eye, eyelashes, and lacrimal system; growth, feeding, and swallowing; the nose; psychosocial factors; and craniofacial reconstruction. CONCLUSIONS In this systematic review, current evidence for the multidisciplinary treatment of Treacher Collins syndrome is provided, recommendations for treatment are made, and a proposed algorithm for treatment is presented. Although some topics are well supported, others, especially ocular, nasal, speech, feeding, and swallowing problems, lack sufficient evidence. In addition, craniofacial surgical reconstruction lacks a sufficient level of evidence to provide a sound basis for a full treatment protocol. Despite the rarity of the syndrome, more research is needed to compare outcomes of several surgical treatments, especially in orbitozygomatic/maxillary regions.
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Abstract
EDUCATIONAL AIMS The reader will be able to: Understand normal sleep patterns in infancyAppreciate disorders of breathing in infancyAppreciate disorders of respiratory control. Normal sleep in infancy is a time of change with alterations in sleep architecture, sleep duration, sleep patterns and respiratory control as an infant grows older. Interactions between sleep and respiration are key to the mechanisms by which infants are vulnerable to sleep disordered breathing. This review discusses normal sleep in infancy, as well as normal sleep breathing in infancy. Sleep disordered breathing (obstructive and central) as well as disorders of ventilatory control and infant causes of hypoventilation are all reviewed in detail.
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Affiliation(s)
- Don S. Urquhart
- Dept of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
- Dept of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory and Sleep Medicine, Royal Brompton Hospital, London, UK
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Feeding difficulties in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015; 44:732-7. [DOI: 10.1016/j.ijom.2015.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/30/2022]
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20
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Caron C, Pluijmers B, Joosten K, Mathijssen I, van der Schroeff M, Dunaway D, Wolvius E, Koudstaal M. Obstructive sleep apnoea in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015; 44:592-8. [DOI: 10.1016/j.ijom.2015.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
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Baugh AD, Wooten W, Chapman B, Drake AF, Vaughn BV. Sleep characteristics in Goldenhar Syndrome. Int J Pediatr Otorhinolaryngol 2015; 79:356-8. [PMID: 25636665 DOI: 10.1016/j.ijporl.2014.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the characteristics of sleep in patients with Goldenhar Syndrome. DESIGN Retrospective review of all polysomnography studies conducted at the University of North Carolina Hospitals between 2003 and 2013 on patients carrying the diagnosis of Goldenhar's Syndrome. RESULTS A preponderance of patients demonstrated severe obstructive sleep apnea and hypercapnia. CONCLUSIONS Patients with Goldenhar Syndrome should be screened for sleep apnea and hypercapnia.
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Affiliation(s)
- A D Baugh
- Department of Surgery, Michigan State University, United States
| | - W Wooten
- Pediatric Specialty Care, East Carolina University, United States
| | - B Chapman
- Department of Neurology, The Ohio State University, United States
| | - A F Drake
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - B V Vaughn
- Division of Sleep and Epilepsy, Department of Neurology, University of North Carolina School of Medicine, United States
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Moraleda-Cibrián M, Edwards SP, Kasten SJ, Buchman SR, Berger M, O'Brien LM. Obstructive sleep apnea pretreatment and posttreatment in symptomatic children with congenital craniofacial malformations. J Clin Sleep Med 2015; 11:37-43. [PMID: 25515281 DOI: 10.5664/jcsm.4360] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/17/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep symptoms are common in children with craniofacial malformations (CFM). However objective data about obstructive sleep apnea (OSA) is still limited. The aims of this study were to investigate the frequency of OSA in symptomatic children with CFM and to determine improvement in severity of OSA after treatment. METHODS Symptomatic children with CFM referred for a diagnostic polysomnogram (PSG) were identified. Obstructive sleep apnea was defined as an apnea/hypopnea index (AHI) ≥ 1, with moderate/severe OSA as an AHI ≥ 5. RESULTS Overall, 151 symptomatic children were identified; 87% were diagnosed with OSA, of whom 24% had moderate-to-severe OSA. Children with syndromic CFM, compared to non-syndromic CFM, were more likely to have an AHI ≥ 5 (syndromic 33% vs. non-syndromic 15%, p = 0.02). Of the 131 children with OSA, 64 were treated and 32 returned for a posttreatment PSG, with 22 treated with either positive airway pressure (PAP) or adenotonsillectomy (AT). Children treated with PAP demonstrated a decrease in AHI from 6.2 to 3.5 (p = 0.057) and an increase in SpO2 from 89.1% to 91.1% (p = 0.091). There were no significant improvements for those in the AT group for either AHI (2.5 to 1.8, p = 0.19) or SpO2 (90.4% to 91.3%, p = 0.46). Normalization of the AHI (AHI < 1) occurred in only one child in each group (7% and 14% of the PAP and AT groups, respectively). CONCLUSIONS The vast majority of children with CFM referred for OSA evaluation are found to have objective evidence of OSA and a quarter of children have moderate-to-severe OSA. It is likely that many children with underlying OSA are not identified and referred for evaluation. Residual OSA after treatment is common in children with CFM.
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Affiliation(s)
- Marta Moraleda-Cibrián
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.,Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Sean P Edwards
- Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Steven J Kasten
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Steven R Buchman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Mary Berger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.,Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.,Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI
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Moraleda-Cibrián M, Berger M, Edwards SP, Kasten SJ, Buchman SR, O'Brien LM. Association between symptoms of sleep-disordered breathing and speech in children with craniofacial malformations. J Clin Sleep Med 2014; 10:671-6. [PMID: 24932148 DOI: 10.5664/jcsm.3798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Sleep-disordered breathing (SDB) and speech difficulties are common problems in children with craniofacial malformations (CFM). The present study was designed to investigate whether resonance issues identified during speech assessment are associated with parental report of SDB symptoms in children with CFM. METHODS Children aged 2-18 years with congenital CFM attending at the Craniofacial Anomalies Program from March 2007 to April 2011 were screened for SDB symptoms using the Sleep-Related Breathing Disturbance Scale of the Pediatric Sleep Questionnaire. Speech evaluation, based on the Pittsburgh Weighted Speech Scale score, was the tool used to investigate velopharyngeal dysfunction (VPD) based on speech perceptual assessment. RESULTS A total of 488 children with congenital CFM were included. Overall 81% were Caucasian and 24% were overweight/obese. Twenty-four percent of children screened positive for SDB and 35% had VPD. Children with VPD were no more likely to screen positive for SDB than children without VPD (26% vs. 23%, p = 0.38). However, children with previous sphincter pharyngoplasty (SP) were more likely to have hyponasality (51% vs. 12%, p = 0.0001) and reduced or absent nasal emission (33% vs. 16%, p = 0.008). In a logistic regression, the adjusted odds ratio for SDB for those with hyponasality was 2.10 (95%CI 1.21-3.61, p = 0.008) and for those with reduced or absent nasal emission was 1.75 (95%CI 1.06-2.88, p = 0.028). CONCLUSION Symptoms of sleep disordered breathing are common in children with craniofacial malformations especially if they have undergone sphincter pharyngoplasty; many of these children can be identified by measures of resonance on routine speech evaluation.
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Affiliation(s)
- Marta Moraleda-Cibrián
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI ; Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Mary Berger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Sean P Edwards
- Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Steven J Kasten
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Steven R Buchman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI ; Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
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Certal V, Camacho M, Winck JC, Capasso R, Azevedo I, Costa-Pereira A. Unattended sleep studies in pediatric OSA: A systematic review and meta-analysis. Laryngoscope 2014; 125:255-62. [DOI: 10.1002/lary.24662] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Victor Certal
- Department of Otorhinolaryngology; University of Porto; Porto Portugal
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - Macario Camacho
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - João C. Winck
- Department of Pulmonology; Faculty of Medicine, University of Porto; Porto Portugal
| | - Robson Capasso
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - Inês Azevedo
- Department of Pediatrics; Faculty of Medicine, University of Porto; Porto Portugal
| | - Altamiro Costa-Pereira
- Hospital Sao Sebastiao, Sta Maria da Feira, and Center for Research in Health Technologies and Information Systems; University of Porto; Porto Portugal
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Moraleda-Cibrián M, Edwards SP, Kasten SJ, Berger M, Buchman SR, O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations. J Clin Sleep Med 2014; 10:307-12. [PMID: 24634629 DOI: 10.5664/jcsm.3536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to investigate the frequency of sleep disordered breathing (SDB) symptoms in a clinical sample of children with congenital craniofacial malformations (CFM) followed at a tertiary medical center and non-selected for sleep problems. METHODS Cross-sectional study of 575 children aged 2-18 years followed at the Craniofacial Anomalies Program between March 2007 and May 2011. The Sleep-Related Breathing Disturbance scale of the Pediatric Sleep Questionnaire was used to screen for SDB, snoring, and sleepiness. A cutoff value ≥ 0.33 of the total answered questions identified children with positive screening for SDB symptoms. RESULTS Overall, 25% of children screened positive for SDB, 28% for snoring, and 20% for sleepiness. In children with non-syndromic CFM, those with Robin sequence had the highest frequency of SDB, snoring, and sleepiness (43%, 44%, and 38%, respectively). In children with syndromic CFM, velocardiofacial/ DiGeorge syndrome had the highest frequency of SDB and sleepiness (48% and 43%, respectively). Children with Treacher Collins had the highest frequency of snoring (83%). The presence of cleft palate was not associated with an increased frequency of SDB symptoms. Nevertheless, children with syndromic CFM, compared to those with non-syndromic CFM, had a higher SDB score (0.27 ± 0.21 vs.0.21 ± 0.19, p = 0.003) and were more likely to have sleepiness (26% vs. 18%, p = 0.05). CONCLUSIONS Congenital craniofacial malformations in children are associated with high risk for SDB symptoms. Our findings should encourage a high index of suspicion for SDB in children with CFM, with a low threshold for further testing and close follow-up. CITATION Moraleda-Cibrián M; Edwards SP; Kasten SJ; Berger M; Buchman SR; O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations.
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Affiliation(s)
- Marta Moraleda-Cibrián
- Sleep Disorders Center, Department of Neurology ; Department of Oral & Maxillofacial Surgery
| | | | - Steven J Kasten
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Mary Berger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Steven R Buchman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology ; Department of Oral & Maxillofacial Surgery
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Heike CL, Hing AV, Aspinall CA, Bartlett SP, Birgfeld CB, Drake AF, Pimenta LA, Sie KC, Urata MM, Vivaldi D, Luquetti DV. Clinical care in craniofacial microsomia: a review of current management recommendations and opportunities to advance research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:271-82. [PMID: 24132932 DOI: 10.1002/ajmg.c.31373] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Craniofacial microsomia (CFM) is a complex condition associated with microtia, mandibular hypoplasia, and preauricular tags. It is the second most common congenital facial condition treated in many craniofacial centers and requires longitudinal multidisciplinary patient care. The purpose of this article is to summarize current recommendations for clinical management and discuss opportunities to advance clinical research in CFM.
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