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Guérin J, Hennocq Q, Paternoster G, Arnaud É, Khonsari RH. Distractor position and distraction amplitude in fronto-facial monobloc advancement : A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101942. [PMID: 38897383 DOI: 10.1016/j.jormas.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of faciocraniosynostoses. In techniques with internal distraction, two sets of devices are generally positioned: bilateral fronto-orbital and temporo-zygomatic distractors, using a temporal tongue and groove osteotomy design. It is believed that distractors must be positioned as parallel as possible in the horizontal and sagittal planes to avoid mechanical conflicts between the sliding bone fragments of the tongue and groove during distraction, and thus optimize the advancement amplitude. Several approaches involving surgical planification and guides for distractor positioning have thus been proposed to monitor distractor placement. To explore the need for surgical planification in distractor placement, the parallelism of the position of the 4 distractors was assessed in 19 FFMBA procedures and we correlated a set of 10 distractor angles with the degree of advancement. We report that the horizontal cut of the tongue and groove can be used as a landmark for the positioning of the lower, temporo-zygomatic, distractor in fronto-facial monobloc advancement. Other parameters (relative position of the two homolateral and the two contralateral distractors and the orientations of the vertical and horizontal cuts of the tongue and groove) do not interfere with distraction, other things being equal. Our results indicate that distractor orientation is not a critical issue in fronto-facial monobloc advancement when devices are positioned as parallel as possible based on visual monitoring.
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Affiliation(s)
- Jade Guérin
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Quentin Hennocq
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Éric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France; Clinique Marcel Sembat, Ramsay, Boulogne-Billancourt, France
| | - Roman Hossein Khonsari
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France.
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Escobar NS, Lim AYL, Amin R. The latest on positive airway pressure for pediatric obstructive sleep apnea. Expert Rev Respir Med 2024; 18:409-421. [PMID: 38949916 DOI: 10.1080/17476348.2024.2375428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/28/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is an important and evolving area in the pediatric population, with significant sequelae when not adequately managed. The use of positive airway pressure (PAP) therapy is expanding rapidly and is being prescribed to patients with persistent OSA post adenotonsillectomy as well as those children who are not surgical candidates including those with medical complexity. AREAS DISCUSSED This article provides a state-of-the-art review on the diagnosis of pediatric OSA and treatment with positive airway pressure (PAP). The initiation of PAP therapy, pediatric interface considerations, PAP mode selection, administration and potential complications of PAP therapy, factors influencing PAP adherence, the use of remote ventilation machine downloads, considerations surrounding follow-up of patients post PAP initiation and evaluation of weaning off PAP will be reviewed. The literature search was conducted via PubMed, Cochrane Library and Google Scholar databases through to March 2024. EXPERT OPINION Further research is required to address barriers to adherence. Further innovation of home monitoring devices for both the diagnosis and assessment of OSA is required, given the limited pediatric sleep medicine resources in several countries worldwide.
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Affiliation(s)
- Natalia S Escobar
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
| | - Adeline Y L Lim
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
- Child Health and Evaluative Science, SickKids Research Institute, Toronto, Canada
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White A, van de Lande LS, O'Hara J, Hartley J, Hayward R, James G, Jeelani NO, Dunaway DJ. Frontofacial Surgery: Reducing Infection with the Development and 6-Year Outcome of a Frontofacial Protocol. Plast Reconstr Surg 2023; 152:833-840. [PMID: 36940153 DOI: 10.1097/prs.0000000000010442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Frontofacial surgery (FFS) creates a communication between the cranial and nasal cavities and is associated with significant infection risk. After a cluster of infections affecting patients undergoing FFS, a root cause analysis of index cases was undertaken, but no specifically remedial causes were identified. Basic principles incorporating known risk factors for the prevention of surgical-site infection were then applied to the creation of a perioperative management protocol. This study analyzes infection rates before and after its implementation. METHODS The protocol was designed around the needs of patients undergoing FFS and consists of three checklists covering their preoperative, intraoperative, and postoperative care. Compliance required the completion of each checklist. All patients undergoing FFS between 1999 and 2019 were studied retrospectively, and infections occurring before and after the implementation of the protocol were analyzed. RESULTS One hundred three patients underwent FFS (60 monobloc and 36 facial bipartition) before the implementation of the protocol in August of 2013, and 30 patients underwent FFS after its implementation. Compliance with the protocol was 95%. After implementation, there was a statistically significant reduction in infections from 41.7% to 13.3% ( P = 0.005). CONCLUSIONS Although no specific cause for a cluster of postoperative infection had been identified, the implementation of a bespoke protocol consisting of preoperative, perioperative, and postoperative checklists covering measures known to reduce infection risk was associated with a significant reduction in postoperative infections in patients undergoing FFS. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Andrea White
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - Lara S van de Lande
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
- University College London, Great Ormond Street Institute of Child Health
| | - Justine O'Hara
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - John Hartley
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - Richard Hayward
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - Greg James
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - N Owase Jeelani
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
| | - David J Dunaway
- From the Craniofacial Unit, Great Ormond Street Hospital for Children NHS Trust
- University College London, Great Ormond Street Institute of Child Health
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Ersu R, Chen ML, Ehsan Z, Ishman SL, Redline S, Narang I. Persistent obstructive sleep apnoea in children: treatment options and management considerations. THE LANCET. RESPIRATORY MEDICINE 2023; 11:283-296. [PMID: 36162413 DOI: 10.1016/s2213-2600(22)00262-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
Abstract
Unresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2-18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. A pressing need exists for a broader, more effective management approach for persistent OSA in children. In this Personal View, we discuss the use and the need for evaluation of current and novel therapeutics, the role of shared decision-making models that consider patient preferences, and the importance of considering the social determinants of health in research and clinical practice. A multipronged, comprehensive approach to persistent OSA might achieve better clinical outcomes in childhood and promote health equity for all children.
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Affiliation(s)
- Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Maida L Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri, Kansas City, KS, USA
| | - Stacey L Ishman
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Ho JPTF, Zhou N, Verbraecken J, Vries ND, Lange JD. Central and mixed sleep apnea related to patients treated with maxillomandibular advancement for obstructive sleep apnea: A retrospective cohort study. J Craniomaxillofac Surg 2022; 50:537-542. [PMID: 35778235 DOI: 10.1016/j.jcms.2022.06.005] [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: 08/06/2021] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the clinical efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) patients with a percentage of central and mixed apnea index in the total apnea-hypopnea index (CMAI%) ≧25%. Patients treated with MMA for OSA were retrospectively evaluated for baseline and postoperative patient data and polysomnographic results. The pre- and postoperative obstructive, central and mixed apnea parameters were compared. Of the included 78 patients, 21 patients (27%) presented with CMAI% ≧25% (median CMAI%, 49.1%; 35.9-63.8) prior to MMA. In 67% of these cases, MMA resulted in CMAI% <25 (median CMAI%, 6.1%; 2.1-8.9) and significantly improved the apnea-hypopnea index (AHI) (p < 0.001), the lowest oxyhemoglobin saturation (p < 0.001), central and mixed apnea index (p < 0.001), percentage of central and mixed apneas of total AHI (p = 0.004), central apnea index (p < 0.001), and mixed apnea index (p < 0.001). CMAI% ≧25% emerged in 25% of patients after MMA (median CMAI%, 49.1%; 35.9-63.8). Within the undeniable limitations of the study, it seems that the presence of CMAI% ≧25% should not be regarded as a contraindication for MMA in OSA patients.
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Affiliation(s)
- Jean-Pierre T F Ho
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.
| | - Ning Zhou
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands.
| | - Jan de Lange
- Amsterdam UMC Location University of Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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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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Hersh DS, Hughes CD. Syndromic Craniosynostosis: Unique Management Considerations. Neurosurg Clin N Am 2021; 33:105-112. [PMID: 34801135 DOI: 10.1016/j.nec.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Craniosynostosis involves the premature fusion of 1 or more cranial sutures and commonly presents as an isolated, nonsyndromic diagnosis. A subset of patients have syndromic craniosynostosis. Several unique considerations must be taken into account when managing patients with syndromic craniosynostosis. A multidisciplinary craniofacial team with a central coordinator is particularly useful for coordinating care among various specialists, and close monitoring is mandatory owing to the increased risk of intracranial hypertension. Surgical management varies among centers, but core options include fronto-orbital advancement with cranial vault remodeling, posterior vault expansion, endoscopic-assisted suturectomy with postoperative orthotic therapy, and midface advancement.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, 282 Washington Street, Hartford, CT 06106, USA; Department of Surgery, UConn School of Medicine, 200 Academic Way, Farmington, CT 06032, USA.
| | - Christopher D Hughes
- Department of Surgery, UConn School of Medicine, 200 Academic Way, Farmington, CT 06032, USA; Divisions of Plastic Surgery and Craniofacial Surgery, Connecticut Children's, 282 Washington Street, Hartford, CT 06106, USA
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Hariri F, Farhana NA, Abdullah NA, Ibrahim N, Ramli NM, Mohd Abdullah AA, May CM, Khaliddin N. Optic canal characteristics in pediatric syndromic craniosynostosis. J Craniomaxillofac Surg 2021; 49:1175-1181. [PMID: 34247917 DOI: 10.1016/j.jcms.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to compare optic canal parameters of syndromic craniosynostosis patients with those of normal patients to visit the possibility of optic nerve impingement as a cause of visual impairment. Computed tomography scan images were processed using the Materialise Interactive Medical Image Control System (MIMICS) Research 21.0 software (Materialise NV, Leuven, Belgium). Eleven optic canal parameters were measured: 1) height of optic canal on the cranial side, 2) height of optic canal on the orbital side 3) length of the medial wall of the optic canal, 4) length of the lateral canal wall of the optic canal, 5) diameter of the optic canal at five points (Q1-Q4 and mid canal), and 6) area and perimeter of optic canal. These measurements were obtained for both the right and left optic canals. The study sample comprised four Crouzon syndrome, five Apert syndrome, and three Pfeiffer syndrome patients. The age of these syndromic craniosynostosis patients ranged from 2 to 63 months. The height of the optic canal on the orbital side (p = 0.041), diameter of the mid canal (p = 0.040), and diameter between the mid-canal and the cranial opening (Q3) (p = 0.079) for syndromic craniosynostosis patients were statistically narrower compared with those of normal patients when a significance level of 0.1 was considered. Scatter plots for the ages of patients versus the above parameters gave three separated clusters that suggested the arresting of optic canal development with age. The findings from this study demonstrated a narrowing of the optic canal in syndromic craniosynostosis patients, and indicate that optic canal anatomical characteristics may have an association with visual impairment among pediatric syndromic craniosynostosis patients.
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Affiliation(s)
- Firdaus Hariri
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Aiman Farhana
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norli Anida Abdullah
- Mathematics Division, Centre for Foundation Studies in Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norliza Ibrahim
- Oro-Craniomaxillofacial Research and Surgical (OCReS) Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Azlindarita Aisyah Mohd Abdullah
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia; Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia
| | - Choo May May
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Julie CP, Pierre-Aurélien B, Mathieu D, Alexandru S, Carmine M, Christian P, Federico DR, Arnaud G. Is computer-assisted design and manufacturing technology useful in the surgical management of trigonocephaly? J Craniomaxillofac Surg 2021; 49:993-999. [PMID: 34187730 DOI: 10.1016/j.jcms.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/15/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to assess the usefulness of CAD/CAM technology in the surgical treatment of trigonocephaly compared to conventional surgical treatment. Children operated from trigonocephaly between 2017 and 2019 at the French Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital of Lyon, France, were included and separated in two groups. Group 1 included children operated on trigonocephaly using CAD-CAM technology; Group 2 included children operated on trigonocephaly without CAD-CAM technology. Age, gender, duration of surgery, complications, blood transfusion and esthetic results were analyzed. The experience of the craniofacial surgeon was also evaluated and quantified in order to weigh the results. Twenty children were included in the study: 10 in the Group 1 and 10 in the Group 2. No statistical difference was observed between these 2 groups concerning the duration of the surgery (137 min ± 39,17 versus 137,2 min ± 64,50; p = 0,85), complications (20% in group 1 versus 10% in group 2; p = 1), the realization of blood transfusion (80% in group 1 versus 70% in group 2) and the esthetic results (5/5 in group 1 versus 4,6/5 in group 2; p = 0,21). However, the use of CAD-CAM technology significantly accelerates the duration of surgery by 25.8 min on average for the surgeon starting in craniofacial surgery (from 197,8 ± 10,21 min without CAD-CAM to 172 ± 18,76 min with CAD-CAM; p = 0.05) but significantly slows the experienced surgeon by 25.4 min on average (from 76,6 ± 8,65 min without CAD-CAM to 102 ± 6,2 min with CAD-CAM; p = 0.01). In the management of trigonocephaly, CAD/CAM technology seems to present a modest interest for the experienced surgeon but presents a real interest for the young surgeon. Within the limitations of the study, it seems that CAD/CAM technology is a relevant addition to the armamentarium of doctors who are in training because surgical time is reduced.
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Affiliation(s)
- Chauvel-Picard Julie
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000, Saint-Etienne, France; Université Jean Monnet, 6 Rue Basse des Rives, 42100, Saint-Étienne, France.
| | - Beuriat Pierre-Aurélien
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Daurade Mathieu
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Szathmari Alexandru
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Mottolese Carmine
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Paulus Christian
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France
| | - Di Rocco Federico
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Gleizal Arnaud
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000, Saint-Etienne, France; Université Jean Monnet, 6 Rue Basse des Rives, 42100, Saint-Étienne, France; Université Claude Bernard Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
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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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Correlation between head shape and volumetric changes following spring-assisted posterior vault expansion. J Craniomaxillofac Surg 2021; 50:343-352. [DOI: 10.1016/j.jcms.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
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Morice A, Cornette R, Giudice A, Collet C, Paternoster G, Arnaud É, Galliani E, Picard A, Legeai-Mallet L, Khonsari RH. Early mandibular morphological differences in patients with FGFR2 and FGFR3-related syndromic craniosynostoses: A 3D comparative study. Bone 2020; 141:115600. [PMID: 32822871 DOI: 10.1016/j.bone.2020.115600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 01/04/2023]
Abstract
Syndromic craniosynostoses are defined by the premature fusion of one or more cranial and facial sutures, leading to skull vault deformation, and midfacial retrusion. More recently, mandibular shape modifications have been described in FGFR-related craniosynostoses, which represent almost 75% of the syndromic craniosynostoses. Here, further characterisation of the mandibular phenotype in FGFR-related craniosynostoses is provided in order to confirm mandibular shape modifications, as this could contribute to a better understanding of the involvement of the FGFR pathway in craniofacial development. The aim of our study was to analyse early mandibular morphology in a cohort of patients with FGFR2- (Crouzon and Apert) and FGFR3- (Muenke and Crouzonodermoskeletal) related syndromic craniosynostoses. We used a comparative geometric morphometric approach based on 3D imaging. Thirty-one anatomical landmarks and eleven curves with sliding semi-landmarks were defined to model the shape of the mandible. In total, 40 patients (12 with Crouzon, 12 with Apert, 12 with Muenke and 4 with Crouzonodermoskeletal syndromes) and 40 age and sex-matched controls were included (mean age: 13.7 months ±11.9). Mandibular shape differed significantly between controls and each patient group based on geometric morphometrics. Mandibular shape in FGFR2-craniosynostoses was characterized by open gonial angle, short ramus height, and high and prominent symphysis. Short ramus height appeared more pronounced in Apert than in Crouzon syndrome. Additionally, narrow inter-condylar and inter-gonial distances were observed in Crouzon syndrome. Mandibular shape in FGFR3-craniosynostoses was characterized by high and prominent symphysis and narrow inter-gonial distance. In addition, narrow condylar processes affected patients with Crouzonodermoskeletal syndrome. Statistical analysis of variance showed significant clustering of Apert and Crouzon, Crouzon and Muenke, and Apert and Muenke patients (p < 0.05). Our results confirm distinct mandibular shapes at early ages in FGFR2- (Crouzon and Apert syndromes) and FGFR3-related syndromic craniosynostoses (Muenke and Crouzonodermoskeletal syndromes) and reinforce the hypothesis of genotype-phenotype correspondence concerning mandibular morphology.
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Affiliation(s)
- A Morice
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France; Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France.
| | - R Cornette
- Institut de Systématique, Evolution, Biodiversité (ISYEB), Muséum National d'Histoire Naturelle, Sorbonne Université, Ecole Pratique des Hautes Etudes, Université des Antilles, CNRS, CP 50, 57 rue Cuvier, 75005 Paris, France
| | - A Giudice
- Università Degli Studi di Catanzaro 'Magna Graecia', Catanzaro, Italy
| | - C Collet
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010 Paris, France; Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - G Paternoster
- Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
| | - É Arnaud
- Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
| | - E Galliani
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France
| | - A Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France
| | - L Legeai-Mallet
- Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France
| | - R H Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France; Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France; Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
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Dowgierd K, Larysz D, Szymor P, Kozakiewicz M. Alterations of upper airway volume caused by Le Fort III osteodistraction in children. J Craniomaxillofac Surg 2020; 48:825-831. [DOI: 10.1016/j.jcms.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/11/2020] [Accepted: 06/20/2020] [Indexed: 12/14/2022] Open
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