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Yamada K, Akita S, Ando N, Tamura T, Hayashi M, Isono S, Mitsukawa N. Changes in mandibular position during midface distraction in patients with syndromic craniosynostosis. J Craniomaxillofac Surg 2024; 52:340-346. [PMID: 38326126 DOI: 10.1016/j.jcms.2024.01.011] [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: 02/25/2023] [Revised: 10/20/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
The purpose of this study was to evaluate changes in mandibular position during midface distraction. Midface distraction was performed in patients with syndromic craniosynostosis to increase upper airway volume. Although this treatment resulted in changes in occlusion, the concomitant changes in mandibular position were poorly understood. In this retrospective study, three-dimensional (3D) cephalograms were obtained before and after midface distraction in 15 patients with syndromic craniosynostosis. Perioperative polysomnography scores and changes in maxillary and mandibular position, mandibular volume, and upper airway volume were analyzed. Results showed a significant improvement in apnea-hypopnea index (AHI) (from 20.6 ± 21.3 to 6.9 ± 5.1, p < 0.05) and upper airway volume (from 2951.65 ± 2286.38 to 5218.04 ± 3150.05 mm3, p < 0.001). When the lowest point of the sella turcica was set as the reference point, the mandible moved significantly in an anterior direction (from 47.9 ± 11.5 to 51.9 ± 9.8 mm, p < 0.05). Mandibular volume did not change significantly perioperatively (from 32530.19 ± 10726.01 to 35590.50 ± 14879.21 mm3, p = 0.10). There were positive correlations between the rates of improvement in AHI and the amount of mandibular movement in the anterior and inferior directions (both p < 0.05). Within the limitations of the study, it seems that the mandible moved in the anterior-inferior direction after midface distraction, and the amount of movement correlated with improvement in respiratory function. Therefore, it is important to consider the position of the mandible when determining the direction of midface distraction, as it may influence the therapeutic effect.
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Affiliation(s)
- Kahoko Yamada
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Ando
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Tamura
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minoru Hayashi
- Department of Plastic and Reconstructive Surgery, St. Mary's Hospital, Fukuoka, Japan
| | - Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
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Kumari K, Saleh I, Taslim S, Ahmad S, Hussain I, Munir Z, Javed T, Virk MFI, Javed S, Bisharat P, Ur Rehman U. Unraveling the Complexity of Apert Syndrome: Genetics, Clinical Insights, and Future Frontiers. Cureus 2023; 15:e47281. [PMID: 38021759 PMCID: PMC10656109 DOI: 10.7759/cureus.47281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Apert syndrome (AS), also known as type I acrocephalosyndactyly, is a rare congenital condition characterized by craniosynostosis resulting from missense mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. This comprehensive review delves into AS, covering its clinical manifestations, genetics, diagnosis, medical management, psychosocial considerations, and future research directions. AS presents with distinct features, including a brachycephalic skull, midface hypoplasia, and limb anomalies such as syndactyly. It follows an autosomal dominant inheritance pattern with mutations in the FGFR2 gene. Prenatal diagnosis is possible through advanced imaging techniques and molecular testing. The multidisciplinary approach to AS management involves surgical interventions, orthodontics, and psychological support. Although no curative treatment exists, early interventions can significantly improve function and aesthetics. The quality of life for AS patients is influenced by psychosocial factors, necessitating comprehensive support for both patients and their families. Future research directions include gene therapy, understanding cellular responses to FGFR2 mutations, and addressing genetic heterogeneity. Collaborative efforts are vital to advancing knowledge about AS and its genetic underpinnings. Overall, this review serves as a valuable resource for healthcare professionals, educators, and researchers, contributing to a deeper understanding of AS and facilitating advancements in diagnosis and treatment.
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Affiliation(s)
- Kajol Kumari
- Dentistry, Jinnah Sindh Medical University, Karachi, PAK
| | - Inam Saleh
- Paediatrics, University of Kentucky College of Medicine, Lexington, USA
| | - Sanzida Taslim
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
| | - Sana Ahmad
- Psychiatry, TIME Organization, Inc., Baltimore, USA
| | - Iqbal Hussain
- Internal Medicine, Khyber Medical University, Peshawar, PAK
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Zainab Munir
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | - Tamleel Javed
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | | | - Saleha Javed
- Emergency Department, Sheikh Zayed Hospital, Rahim Yar Khan, PAK
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3
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Schlieder D, Markiewicz MR. Craniofacial Syndromes: The Le Fort III Osteotomy for Correction of Severe Midface Hypoplasia. Atlas Oral Maxillofac Surg Clin North Am 2022; 30:85-99. [PMID: 35256113 DOI: 10.1016/j.cxom.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Daniel Schlieder
- Department of Oral and Maxillofacial Surgery, San Antonio Military Medical Center, San Antonio, TX; Craniofacial Anomaly Team, Wilford Hall Surgery Center, Lackland AFB TX.
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, 3435 Main Street, 112 Squire Hall, Buffalo, NY 14214, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY; Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY; Roswell Park Comprehensive Cancer Center, Buffalo, NY
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4
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Wang MM, Haveles CS, Zukotynski BK, Reid RR, Lee JC. Facial Suture Pathology in Syndromic Craniosynostosis: Human and Animal Studies. Ann Plast Surg 2021; 87:589-599. [PMID: 34699435 PMCID: PMC8667083 DOI: 10.1097/sap.0000000000002822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Facial deformities in syndromic craniosynostosis are not only functionally, psychosocially, and aesthetically impairing but also notoriously challenging to reconstruct. Whether facial suture synostosis plays a significant role in the pathogenesis of these deformities is inadequately studied in human patients. METHODS The MEDLINE database was queried using a methodologically generated search term inventory. Article inclusion was adjudicated by 2 authors after independent review. Articles provided insight into facial suture involvement in either syndromic craniosynostosis patients or animal models of disease. RESULTS Comprehensive review yielded 19 relevant articles meeting inclusion criteria. Mid-20th century craniofacial biologists characterized how patent facial sutures are essential for normal postnatal facial development. They also posited that premature ossification disrupts growth vectors, causing significant dysmorphologies. Recently, facial suture synostosis was found to cause midfacial deformities independent of cranial base pathology in mouse models of syndromic craniosynostosis. Few recent studies have begun exploring facial suture involvement in patients, and although they have paved the way for future research, they bear significant limitations. CONCLUSIONS The hypothesis that facial suture synostosis acts in conjunction with cranial base pathology to produce the prominent, multifocal facial deformities in syndromic craniosynostosis may fundamentally alter surgical management and warrants further investigation. Methodically evaluating the literature, this review synthesizes all basic science and human clinical research thus far on the role of facial sutures in syndromic craniosynostosis and elucidates important topics for future research. We ultimately identify the need for rigorous imaging studies that longitudinally evaluate facial osteology across patients with various craniosynostosis syndromes.
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Affiliation(s)
- Maxwell M. Wang
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Christos S. Haveles
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Brian K. Zukotynski
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Russell R. Reid
- Section of Plastic and Reconstructive Surgery; University of Chicago, Chicago, Illinois
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
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5
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Cross C, Khonsari RH, Larysz D, Johnson D, Kölby L, Moazen M. Predicting and comparing three corrective techniques for sagittal craniosynostosis. Sci Rep 2021; 11:21216. [PMID: 34707183 PMCID: PMC8551239 DOI: 10.1038/s41598-021-00642-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
Sagittal synostosis is the most occurring form of craniosynostosis, resulting in calvarial deformation and possible long-term neurocognitive deficits. Several surgical techniques have been developed to correct these issues. Debates as to the most optimal approach are still ongoing. Finite element method is a computational tool that's shown to assist with the management of craniosynostosis. The aim of this study was to compare and predict the outcomes of three reconstruction methods for sagittal craniosynostosis. Here, a generic finite element model was developed based on a patient at 4 months of age and was virtually reconstructed under all three different techniques. Calvarial growth was simulated to predict the skull morphology and the impact of different reconstruction techniques on the brain growth up to 60 months of age. Predicted morphology was then compared with in vivo and literature data. Our results show a promising resemblance to morphological outcomes at follow up. Morphological characteristics between considered techniques were also captured in our predictions. Pressure outcomes across the brain highlight the potential impact that different techniques have on growth. This study lays the foundation for further investigation into additional reconstructive techniques for sagittal synostosis with the long-term vision of optimizing the management of craniosynostosis.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, UK
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, School of Medicine, Necker - Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
| | - Dawid Larysz
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn. Ul, Zolnierska 18a, 10-561, Olsztyn, Poland
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK.
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Cross C, Khonsari RH, Galiay L, Patermoster G, Johnson D, Ventikos Y, Moazen M. Using Sensitivity Analysis to Develop a Validated Computational Model of Post-operative Calvarial Growth in Sagittal Craniosynostosis. Front Cell Dev Biol 2021; 9:621249. [PMID: 34124030 PMCID: PMC8187911 DOI: 10.3389/fcell.2021.621249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Craniosynostosis is the premature fusion of one or more sutures across the calvaria, resulting in morphological and health complications that require invasive corrective surgery. Finite element (FE) method is a powerful tool that can aid with preoperative planning and post-operative predictions of craniosynostosis outcomes. However, input factors can influence the prediction of skull growth and the pressure on the growing brain using this approach. Therefore, the aim of this study was to carry out a series of sensitivity studies to understand the effect of various input parameters on predicting the skull morphology of a sagittal synostosis patient post-operatively. Preoperative CT images of a 4-month old patient were used to develop a 3D model of the skull, in which calvarial bones, sutures, cerebrospinal fluid (CSF), and brain were segmented. Calvarial reconstructive surgery was virtually modeled and two intracranial content scenarios labeled “CSF present” and “CSF absent,” were then developed. FE method was used to predict the calvarial morphology up to 76 months of age with intracranial volume-bone contact parameters being established across the models. Sensitivity tests with regards to the choice of material properties, methods of simulating bone formation and the rate of bone formation across the sutures were undertaken. Results were compared to the in vivo data from the same patient. Sensitivity tests to the choice of various material properties highlighted that the defined elastic modulus for the craniotomies appears to have the greatest influence on the predicted overall skull morphology. The bone formation modeling approach across the sutures/craniotomies had a considerable impact on the level of contact pressure across the brain with minimum impact on the overall predicated morphology of the skull. Including the effect of CSF (based on the approach adopted here) displayed only a slight reduction in brain pressure outcomes. The sensitivity tests performed in this study set the foundation for future comparative studies using FE method to compare outcomes of different reconstruction techniques for the management of craniosynostosis.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Roman H Khonsari
- Service de Chirurgie Maxillo-Faciale et Plastique, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Leila Galiay
- Service de Chirurgie Maxillo-Faciale et Plastique, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Giovanna Patermoster
- Department of Neurosurgery, Craniofacial 16 Surgery Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de 17 Paris, Université de Paris, Paris, France
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, NHS Foundation Trust, Oxford, United Kingdom
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, United Kingdom
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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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8
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Khonsari RH, Haber S, Paternoster G, Fauroux B, Morisseau-Durand MP, Cormier-Daire V, Legeai-Mallet L, James S, Hennocq Q, Arnaud E. The influence of fronto-facial monobloc advancement on obstructive sleep apnea: An assessment of 109 syndromic craniosynostoses cases. J Craniomaxillofac Surg 2020; 48:536-547. [DOI: 10.1016/j.jcms.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
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9
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Mathews F, Shaffer AD, Georg MW, Ford MD, Goldstein JA, Jabbour N, Simons JP. Airway anomalies in patients with craniosynostosis. Laryngoscope 2018; 129:2594-2602. [DOI: 10.1002/lary.27589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Fasil Mathews
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | | | | | - Matthew D. Ford
- Department of Pediatric Plastic SurgeryChildren's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania U.S.A
| | | | - Noel Jabbour
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Jeffrey P. Simons
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
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10
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Mathews F, Shaffer AD, Georg MW, Ford MD, Jabbour N, Simons JP. Laryngomalacia in Patients With Craniosynostosis. Ann Otol Rhinol Laryngol 2018; 127:543-550. [DOI: 10.1177/0003489418779413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To characterize differences in the clinical presentation and treatment outcomes of laryngomalacia in patients with and without craniosynostosis. Methods: A retrospective cohort study was performed comparing all patients with concomitant laryngomalacia and craniosynostosis seen at a tertiary care children’s hospital between 2000 and 2016 with a control group of patients with isolated laryngomalacia. Thirty-two patients with craniosynostosis (59% male) and 68 control patients (56% male) were included. There were no significant differences in age of diagnosis or incidence of prematurity. Symptom presentation, disease severity, swallowing function, comorbidities, treatment modalities, and outcomes were examined using logistic regression. Results: Patients with craniosynostosis had increased odds of presenting with stertor (odds ratio [OR] = 3.41, P = .022), increased work of breathing (OR = 18.8, P = .007), obstructive sleep apnea (OR = 8.48, P = .003), dysphagia (OR = 3.40, P = .008), and aspiration (OR = 40.2, P < .001) and decreased odds of presenting with stridor (OR = 0.0804, P < .001) compared with controls. Patients with craniosynostosis had increased odds of severe laryngomalacia (OR = 5.00, P = .031) and other airway anomalies such as tracheomalacia (OR = 5.73, P = .004), bronchomalacia (OR = 15.5, P = .013), and subglottic stenosis (OR = 2.75, P = .028). Treatment of patients with craniosynostosis was more likely to include tracheostomy (OR = 24.8, P < .001) and gastrostomy tube (OR = 88.4, P < .001). There were no significant differences in rates of supraglottoplasty. Conclusion: Clinical presentations, comorbidities, and treatments of laryngomalacia are significantly different in the context of craniosynostosis.
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Affiliation(s)
- Fasil Mathews
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amber D. Shaffer
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew W. Georg
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D. Ford
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P. Simons
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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11
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Müller-Hagedorn S, Wiechers C, Arand J, Buchenau W, Bacher M, Krimmel M, Reinert S, Poets CF. Less invasive treatment of sleep-disordered breathing in children with syndromic craniosynostosis. Orphanet J Rare Dis 2018; 13:63. [PMID: 29688857 PMCID: PMC5914055 DOI: 10.1186/s13023-018-0808-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants and children with syndromic craniosynostosis (SCS), such as Apert-, Crouzon- or Pfeiffer syndrome, are prone to sleep disordered breathing (SDB) including obstructive sleep apnea and upper airway resistance syndrome (OSAS, UARS), potentially leading to tracheostomy. We modified the Tübingen Palatal Plate (TPP), an oral appliance with a velar extension effectively treating airway obstruction in Robin sequence, by attaching a tube to its velar extension to bridge the narrow pharyngeal airway in SCS patients. Here, we evaluated this treatment concept. METHODS Our hospital's electronic patient files were searched for all children with a diagnosis of SCS admitted between 01/01/2004 and 31/12/2016. Children with isolated craniosynostosis were excluded. OSAS was defined as a mixed-obstructive apnea-hypopnea index (MOAHI) > 1, and UARS as more than 1 episode with nasal flow limitation/h, but absent OSAS. Children with a diagnosis of OSAS received the TPP and fiberoptic nasopharyngoscopy to assess the type of obstruction and to adjust the plate. Growth and weight gain, determined as standard deviation scores, were also evaluated before and during treatment. RESULTS Of 34 patients included, 24 presented with SDB (19 OSAS, 5 UARS) and 27 had midface hypoplasia. Proportions of SDB were 78% in those with, and 22% in those without midface hypoplasia. In the OSAS group (n = 19), 13 patients were treated with palatal plates, with the remaining receiving continuous positive airway pressure, midface surgery or tracheal intubation. The MOAHI decreased across all children receiving palatal plate treatment from 14.6 (range 0.0-50.7) at admission to 0.9 (range 0.0-3.5) at discharge (p = 0.002). SDS for weight and body length also improved (p < 0.05 for weight and p = 0.05 for body length). Only one child required tracheostomy. CONCLUSION Treatment of upper airway obstruction by a modified TPP in these children with SCS was shown to be mostly effective and safe. If confirmed in larger prospective studies, it may help to avoid more invasive interventions.
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Affiliation(s)
- Silvia Müller-Hagedorn
- Department of Orthodontics, Rostock University Hospital, Rostock, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany.,Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Wolfgang Buchenau
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | | | - Michael Krimmel
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Siegmar Reinert
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany. .,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany.
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12
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Abstract
A number of textbooks, review articles, and case reports highlight the potential comorbidity of choanal atresia in craniosynostosis patients. However, the lack of a precise definition of choanal atresia within the current craniosynostosis literature and widely varying methods of detection and diagnosis have produced uncertainty regarding the true coincidence of these conditions. The authors review the anatomy and embryologic basis of the human choanae, provide an overview of choanal atresia, and analyze the available literature that links choanal atresia and craniosynostosis. Review of over 50 case reports that describe patients diagnosed with both conditions reveals inconsistent descriptions of choanal atresia and limited use of definitive diagnostic methodologies. The authors further present preliminary analysis of three-dimensional medical head computed tomographic scans of children diagnosed with craniosynostosis syndromes (e.g., Apert, Pfeiffer, Muenke, and Crouzon) and typically developing children and, although finding no evidence of choanal atresia, report the potentially reduced nasal airway volumes in children diagnosed with Apert and Pfeiffer syndromes. A recent study of the Fgfr2c Crouzon/Pfeiffer syndrome mouse model similarly found a significant reduction in nasal airway volumes in littermates carrying this FGFR2 mutation relative to unaffected littermates, without detection of choanal atresia. The significant correlation between specific craniosynostosis syndromes and reduced nasal airway volume in mouse models for craniosynostosis and human pediatric patients indicates comorbidity of choanal and nasopharyngeal dysmorphologies and craniosynostosis conditions. Genetic, developmental, and epidemiologic sources of these interactions are areas particularly worthy of further research.
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Nakajima Y, Nakano H, Sumida T, Yamada T, Inoue K, Sugiyama G, Mishima K, Mori Y. High Le Fort I osteotomy for correction of mid-face deformity in Crouzon syndrome. Congenit Anom (Kyoto) 2016; 56:240-2. [PMID: 27092811 DOI: 10.1111/cga.12168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/09/2016] [Accepted: 04/12/2016] [Indexed: 12/27/2022]
Abstract
An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome.
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Affiliation(s)
- Yasumichi Nakajima
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Nakano
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Dental and Maxillofacial Center, Kyushi University Hospital, Fukuoka, Japan
| | - Tomoki Sumida
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Dental and Maxillofacial Center, Kyushi University Hospital, Fukuoka, Japan
| | - Tomohiro Yamada
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Dental and Maxillofacial Center, Kyushi University Hospital, Fukuoka, Japan
| | - Kazuya Inoue
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Goro Sugiyama
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yoshihide Mori
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Dental and Maxillofacial Center, Kyushi University Hospital, Fukuoka, Japan
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14
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Tsui WK, Yang Y, Cheung LK, Leung YY. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome: A systematic review. Medicine (Baltimore) 2016; 95:e4674. [PMID: 27603361 PMCID: PMC5023883 DOI: 10.1097/md.0000000000004674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To conduct a systematic review to answer the clinical question "What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?". METHODS A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. RESULTS Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. CONCLUSION This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular advancement surgery for OSAS patients and to provide a better evidence on the success and complication rates of the techniques.
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Affiliation(s)
| | - Yanqi Yang
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, People Republic of China
| | | | - Yiu Yan Leung
- Oral and Maxillofacial Surgery
- Correspondence: Dr Yiu Yan Leung, Oral and Maxillofacial Surgery, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People Republic of China (e-mail: )
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15
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Cielo CM, Montalva FM, Taylor JA. Craniofacial disorders associated with airway obstruction in the neonate. Semin Fetal Neonatal Med 2016; 21:254-62. [PMID: 26997148 PMCID: PMC4967408 DOI: 10.1016/j.siny.2016.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In infants with craniofacial disorders, upper airway obstruction is one of the primary causes for morbidity and mortality in the neonatal period. Infants with craniofacial disorders, including Pierre Robin sequence, are at high risk for obstructive sleep apnea syndrome. Because of the complexity of their care, these neonates are usually followed by a multidisciplinary team to ensure timely evaluation and optimal treatment. In addition to history and physical examination, clinical evaluation may include genetic testing, imaging, endoscopy, and polysomnography. There are various treatment options, both surgical and non-surgical, that may be used depending on clinical assessment, underlying condition, and severity of disease. Recent advances have led to better assessment and treatment of these patients, but many questions remain. This review outlines the available literature pertaining to the evaluation and management of upper airway obstruction in the neonate with craniofacial conditions, with a particular focus on Pierre Robin sequence.
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Affiliation(s)
- Christopher M. Cielo
- Perelman School of Medicine at the University of Pennsylvania, Division of Pulmonary Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Corresponding author. Address: 9NW50, Main Hospital, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. Tel.: +1 267-426-5842; fax: +1 267-426-9234. (C.M. Cielo)
| | | | - Jesse A. Taylor
- Perelman School of Medicine at the University of Pennsylvania, Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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16
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Cielo CM, Konstantinopoulou S, Hoque R. OSAS in Specific Pediatric Populations. Curr Probl Pediatr Adolesc Health Care 2016; 46:11-8. [PMID: 26563522 DOI: 10.1016/j.cppeds.2015.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Christopher M Cielo
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, PA.
| | | | - Romy Hoque
- Department of Neurology, Emory University School of Medicine, GA
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17
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Doerga PN, Spruijt B, Mathijssen IMJ, Wolvius EB, Joosten KFM, van der Schroeff MP. Upper airway endoscopy to optimize obstructive sleep apnea treatment in Apert and Crouzon syndromes. J Craniomaxillofac Surg 2015; 44:191-6. [PMID: 26712482 DOI: 10.1016/j.jcms.2015.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/09/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is highly prevalent in children with Apert and Crouzon syndromes. Although often related to midface hypoplasia, it is a multi-level problem for which routine midface advancement might be a suboptimal treatment choice. We therefore wished to: 1.) use upper airway endoscopy to examine the level of obstruction in children with OSA; 2.) determine the relationship between endoscopic assessment and OSA severity; and 3.) evaluate the effect of surgery on endoscopic assessment and OSA severity. METHODS Prospective observational cohort study of patients considered for midface advancement, underwent upper airway endoscopy. Endoscopy findings were scored according to the system of Bachar, based on level (nose, uvulopalatine plane, tongue base, hypopharynx and larynx); and severity (no, partial or complete obstruction). Polysomnography was used to diagnose OSA. RESULTS We included 22 children (Apert N = 10, Crouzon N = 12), 17 had OSA, 14 of whom had multilevel obstruction and 3 single-level obstruction. The endoscopy findings were correlated with OSA severity: R = 0.56, P = 0.01. Midface advancement (N = 8) reduced Bachar's severity index in 7 of 8 patients, and OSA in all patients. CONCLUSIONS OSA in children with Apert or Crouzon syndrome is often a multi-level problem. Upper airway endoscopy is essential to optimizing OSA treatment.
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Affiliation(s)
- Priya N Doerga
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands.
| | - Bart Spruijt
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands
| | - Irene M J Mathijssen
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, The Netherlands
| | - Eppo B Wolvius
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Oral and Maxillofacial Surgery, The Netherlands
| | - Koen F M Joosten
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Pediatric Intensive Care Unit, The Netherlands
| | - Marc P van der Schroeff
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Otorhinolaryngology, The Netherlands
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18
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Inverso G, Brustowicz KA, Katz E, Padwa BL. The prevalence of obstructive sleep apnea in symptomatic patients with syndromic craniosynostosis. Int J Oral Maxillofac Surg 2015; 45:167-9. [PMID: 26602951 DOI: 10.1016/j.ijom.2015.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/24/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
The reported prevalence of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS) varies due to inconsistent definitions of OSA, lack of uniform diagnostic testing, and different mixes of syndromic diagnoses. The purpose of this study was to determine the prevalence of OSA in symptomatic patients with SCS, and to determine whether this differs by phenotypic diagnosis. A retrospective cohort study of children with SCS was conducted. The primary outcome was presence of OSA diagnosed by polysomnography. The prevalence of OSA was calculated and stratified by diagnosis to compare differences in prevalence and severity (mild, moderate, or severe). The prevalence of OSA in symptomatic patients was 74.2%. Patients with Apert syndrome had the highest prevalence (80.6%), followed by Pfeiffer, Crouzon with acanthosis nigricans, and Crouzon syndromes (72.7%, 66.7%, and 64.7%, respectively). Severe OSA was most common in patients with Pfeiffer syndrome (45.5%), while patients with Apert and Crouzon syndromes were more likely to have moderate OSA (29.0% and 23.5%, respectively). Given that 56.4% of patients with SCS are symptomatic and that 74.2% of these symptomatic patients have OSA, it is recommended that a screening level I polysomnography be part of the clinical care for all patients with SCS.
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Affiliation(s)
- G Inverso
- Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - K A Brustowicz
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - E Katz
- Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - B L Padwa
- Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
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19
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Obstructive sleep apnoea in children with craniofacial syndromes. Paediatr Respir Rev 2015; 16:189-96. [PMID: 25555676 PMCID: PMC4454627 DOI: 10.1016/j.prrv.2014.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is common in children. Craniofacial anomalies such as cleft palate are among the most common congenital conditions. Children with a variety of craniofacial conditions, including cleft palate, micrognathia, craniosynostosis, and midface hypoplasia are at increased risk for OSAS. Available evidence, which is largely limited to surgical case series and retrospective studies, suggests that OSAS can be successfully managed in these children through both surgical and non-surgical techniques. Prospective studies using larger cohorts of patients and including polysomnograms are needed to better understand the risk factors for this patient population and the efficacy of treatment options for OSAS and their underlying conditions.
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21
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Kumar GR, Jyothsna M, Ahmed SB, Sree Lakshmi KR. Apert's Syndrome. Int J Clin Pediatr Dent 2014; 7:69-72. [PMID: 25206244 PMCID: PMC4144061 DOI: 10.5005/jp-journals-10005-1239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/05/2013] [Indexed: 11/23/2022] Open
Abstract
Apert's syndrome (acrocephalosyndactyly) is a rare congenital disorder characterized by craniosynostosis, midfacial malforma-tion and symmetrical syndactyly of hands and feet. Craniofacial deformities include cone-shaped calvarium, fat forehead, prop-tosis, hypertelorism and short nose with a bulbous tip. Intraoral findings include high arched palate with pseudocleft, maxillary transverse and sagittal hypoplasia with concomitant dental crowding, skeletal and dental anterior open bite and several retained primary teeth. We report one such case of 14-year-old boy having all the classical features of Apert's syndrome with particular emphasis on brief review of genetic features. How to cite this article: Kumar GR, Jyothsna M, Ahmed SB, Lakshmi KRS. Apert's Syndrome. Int J Clin Pediatr Dent 2014;7(1):69-72.
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Affiliation(s)
- Gudipaneni Ravi Kumar
- Assistant Professor, Department of Pedodontics and Preventive Dentistry Government Dental College and Hospital, Rims, Kadapa Andhra Pradesh, India
| | - Mandapati Jyothsna
- Assistant Professor, Department of Oral Pathology, Government Dental College and Hospital, Rims, Kadapa, Andhra Pradesh, India
| | - Syed Basheer Ahmed
- Associate Professor, Department of Prosthodontics, Crown and Bridge, Government Dental College and Hopital, Rims, Kadapa, Andhra Pradesh India
| | - Ketham Reddy Sree Lakshmi
- Tutor, Department of Pedodontics and Preventive Dentistry Government Dental College and Hospital, Rims, Kadapa Andhra Pradesh, India
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Abstract
Adenotonsillectomy is the most common surgery performed for sleep disordered breathing with good outcomes. Children with obesity, craniofacial disorders, and neurologic impairment are at risk for persistent sleep apnea after adenotonsillectomy. Techniques exist to address obstructive lesions of the palate, tongue base, or craniofacial skeleton in children with persistent sleep apnea. Children with obstructive sleep apnea have a higher rate of peri-operative complications.
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Affiliation(s)
- Cecille G Sulman
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin , Milwaukee, WI , USA
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23
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Driessen C, Joosten KFM, Bannink N, Bredero-Boelhouwer HH, Hoeve HLJ, Wolvius EB, Rizopoulos D, Mathijssen IMJ. How does obstructive sleep apnoea evolve in syndromic craniosynostosis? A prospective cohort study. Arch Dis Child 2013; 98:538-43. [PMID: 23702437 DOI: 10.1136/archdischild-2012-302745] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the course of obstructive sleep apnoea syndrome (OSAS) in children with syndromic craniosynostosis. DESIGN Prospective cohort study. SETTING Dutch Craniofacial Centre from January 2007 to January 2012. PATIENTS A total of 97 children with syndromic craniosynostosis underwent level III sleep study. Patients generally undergo cranial vault remodelling during their first year of life, but OSAS treatment only on indication. MAIN OUTCOME MEASURES Obstructive apnoea-hypopnoea index, the central apnoea index and haemoglobin oxygenation-desaturation index derived from consecutive sleep studies. RESULTS The overall prevalence of OSAS in syndromic craniosynostosis was 68% as defined by level III sleep study. Twenty-three patients were treated for OSAS. Longitudinal profiles were computed for 80 untreated patients using 241 sleep studies. A mixed effects model showed higher values for the patients with midface hypoplasia as compared to those without midface hypoplasia (Omnibus likelihood ratio test=7.9). In paired measurements, the obstructive apnoea-hypopnoea index (Z=-3.4) significantly decreased over time, especially in the first years of life (Z=-3.3), but not in patients with midface hypoplasia (Z=-1.5). No patient developed severe OSAS during follow-up if it was not yet diagnosed during the first sleep study. CONCLUSIONS OSAS is highly prevalent in syndromic craniosynostosis. There is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome. In the absence of other co-morbid risk factors, it is highly unlikely that if severe OSAS is not present early in life it will develop during childhood. Ongoing clinical surveillance is of great importance and continuous monitoring for the development of other co-morbid risk factors for OSAS should be warranted.
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Affiliation(s)
- Caroline Driessen
- Department of Plastic, Reconstructive, and Hand Surgery, Dutch Craniofacial Centre, Erasmus Medical Centre--Sophia Children's Hospital, Rotterdam, The Netherlands.
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Analysis of Routine Intensive Care Unit Admission following Fronto-Orbital Advancement for Craniosynostosis. Plast Reconstr Surg 2013; 131:582e-588e. [DOI: 10.1097/prs.0b013e3182818e94] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adenotonsillectomy for the management of obstructive sleep apnea in children with congenital craniosynostosis syndromes. J Craniofac Surg 2013; 23:1020-2. [PMID: 22777462 DOI: 10.1097/scs.0b013e31824e6cf8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Children with congenital craniosynostosis syndromes have a high incidence of obstructive sleep apnea (OSA). Obstructive sleep apnea has significant consequences including impaired growth, learning and behavioral problems, and cardiovascular morbidity. Adenotonsillectomy is the treatment of choice for OSA in otherwise healthy children. In children with craniosynostosis syndromes, airway abnormalities may exist at multiple levels, but midface hypoplasia leading to a reduced nasopharyngeal airway is a common significant factor; here, even normal-sized adenoids and tonsils may contribute to obstruction. To date, few studies have evaluated adenotonsillectomy for the treatment of OSA in children with syndromic craniosynostosis. In this study, we assessed the effectiveness of adenotonsillectomy by comparing preoperative and postoperative sleep study data. We also evaluated whether adenotonsillectomy could obviate the need for tracheostomy in these patients. Five children with syndromic craniosynostosis and moderate to severe OSA underwent adenotonsillectomy at a mean age of 4.0 years (range, 1.7-5.1 y). Two patients (40%) showed improvement in OSA severity grade and 1 patient had complete resolution. Three children (60%) avoided tracheostomy and had no further airway surgery. Our results provide evidence to support the use of adenotonsillectomy in treating OSA in children with syndromic craniosynostosis. Adenotonsillectomy should be considered before tracheostomy or more major surgery in this patient group.
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Antón-Pacheco JL, Luna Paredes C, Martínez Gimeno A, García Hernández G, Martín de la Vega R, Romance García A. The role of bronchoscopy in the management of patients with severe craniofacial syndromes. J Pediatr Surg 2012; 47:1512-5. [PMID: 22901909 DOI: 10.1016/j.jpedsurg.2012.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/20/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to assess the incidence of airway anomalies in children with severe craniofacial syndromes and to establish the role of bronchoscopy in the care of these patients. METHODS Consecutive children with craniofacial syndromes, including both bony deformities of the skull and face, in which a bronchoscopy was performed between 1995 and 2010 were retrospectively reviewed. RESULTS Thirty-six patients (22 boys, 14 girls; mean age, 39 months) were studied. Craniofacial synostosis was present in 21 patients (Crouzen syndrome, 11; Apert syndrome, 7, Pfeiffer syndrome, 3) and craniofacial dysostosis in 15 (Goldenhart syndrome, 8; Treacher Collins syndrome, 7). In 30 patients (83.3%), bronchoscopy was performed because of respiratory symptoms (apneic episodes, 22; respiratory distress, 13; stridor, 6; cyanosis, 1) and, in the remaining 6 (asymptomatic children), during guided tracheal intubation before a surgical procedure. Airway anomalies were found in 69.4% of patients (70% in symptomatic patients). Management consisted of tracheotomy in 13 patients, adenoidectomy/tonsillectomy in 13, glossopexy in 5, antireflux surgery in 3, and supraglottoplasty in 2. CONCLUSIONS Airway anomalies occurred in 70% of children with severe craniofacial syndromes and respiratory symptoms. Bronchoscopy should be performed routinely in this selected group of patients, and the entire airway must be examined. Treatment should be tailored to each individual patient.
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Affiliation(s)
- Juan L Antón-Pacheco
- Pediatric Airway Unit, Division of Pediatric Surgery, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, E-28041, Spain.
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27
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Plomp RG, Bredero-Boelhouwer HH, Joosten KFM, Wolvius EB, Hoeve HLJ, Poublon RML, Mathijssen IMJ. Obstructive sleep apnoea in Treacher Collins syndrome: prevalence, severity and cause. Int J Oral Maxillofac Surg 2012; 41:696-701. [PMID: 22521672 DOI: 10.1016/j.ijom.2012.01.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 11/21/2011] [Accepted: 01/20/2012] [Indexed: 11/26/2022]
Abstract
This cohort study in 35 patients (13 children) evaluates the prevalence, severity and anatomical cause of obstructive sleep apnoea syndrome (OSAS) in patients with Treacher Collins syndrome. Ambulatory polysomnography was performed cross-sectionally to determine OSAS prevalence and severity. All upper airway related surgical interventions were evaluated retrospectively. In 11 patients, sleep endoscopy, and flexible and rigid endoscopy were applied to determine the level of anatomical obstruction of the upper airway. The overall prevalence of OSAS in Treacher Collins patients was 46% (54% in children; 41% in adults). Thirty-eight upper airway related surgical interventions were performed in 17 patients. Examination of the upper airway revealed various anatomical levels of obstruction, from the nasal septum to the trachea. Most significant obstruction was found at the level of the oro/hypopharynx. OSAS in Treacher Collins patients is an important problem so all patients should be screened for OSAS by polysomnography. Endoscopy of the upper airways was helpful in determining the level of obstruction. Surgical treatment at one level will not resolve OSAS in most patients because OSAS in Treacher Collins has a multilevel origin. Non-invasive ventilation (continuous positive airway pressure or bilevel positive airway pressure) or tracheotomy should be considered as a treatment modality.
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Affiliation(s)
- R G Plomp
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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28
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Adil E, Huntley C, Choudhary A, Carr M. Congenital nasal obstruction: clinical and radiologic review. Eur J Pediatr 2012; 171:641-50. [PMID: 21964985 DOI: 10.1007/s00431-011-1591-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
Abstract
Congenital nasal obstruction can result in neonatal respiratory distress because neonates are obligate nasal breathers. Therefore, all physicians who deal with infants should be familiar with the structural abnormalities, masses, and syndromes that cause nasal obstruction, so that appropriate work-up and treatment can be promptly initiated. This paper reviews the embryology of the nasal passage and then continues with the different causes of nasal obstruction. Special attention is paid to the presentation, physical exam findings, and imaging modality of choice.
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Affiliation(s)
- Eelam Adil
- Division of Otolaryngology-Head and Neck Surgery, Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
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Volumetric Analysis of Anterior Versus Posterior Cranial Vault Expansion in Patients With Syndromic Craniosynostosis. J Craniofac Surg 2012; 23:455-8. [DOI: 10.1097/scs.0b013e318240ff49] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fronto-facial monobloc distraction in syndromic craniosynostosis. Three-dimensional evaluation of treatment outcome and facial growth. Int J Oral Maxillofac Surg 2011; 41:20-7. [PMID: 22094394 DOI: 10.1016/j.ijom.2011.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/20/2011] [Accepted: 09/20/2011] [Indexed: 11/23/2022]
Abstract
The objectives of this study were to investigate the treatment effect and stability of fronto-facial monobloc distraction osteogenesis. Five consecutive patients who underwent monobloc distraction were included (aged 4.8-18.4 years). Three patients had Crouzon syndrome, one had Apert syndrome, and one had Pfeiffer syndrome. The evaluation included clinical records, serial cephalograms for at least 1-year follow up (average 24.6 months). The treatment and post-treatment changes were measured. The intracranial volume, upper airway volume and globe protrusion were calculated from CT before and after treatment. After distraction, the supraorbital region was advanced 15.3mm forward, the midface demonstrated forward advancement of 17.7 mm, 22.1mm and 23.1mm at orbitale, anterior nasal spine and A point, respectively. The downward movement was 2-3mm at maxillary level. The intracranial volume increased 11%; the upper airway volume increased 85% on average. Globe protrusion reduced 3.7 mm on average, which was 20% of underlying skeletal movement. Facial growth demonstrated forward remodelling of the supraorbital region, mild downward but no further forward growth of the midface. Monobloc distraction is effective for relieving related symptoms and signs through differential external distraction at different vertical levels of the face.
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Management of obstructive sleep apnea associated with Down syndrome and other craniofacial dysmorphologies. Curr Opin Pulm Med 2011; 17:431-6. [DOI: 10.1097/mcp.0b013e32834ba9c0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tracheobronchial Anomalies in Syndromic Craniosynostosis With 3-Dimensional CT Image and Bronchoscopy. J Craniofac Surg 2011; 22:1579-83. [DOI: 10.1097/scs.0b013e31822e5d15] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Obstructive sleep apnea-specific quality of life and behavioral problems in children with syndromic craniosynostosis. J Dev Behav Pediatr 2011; 32:233-8. [PMID: 21297497 DOI: 10.1097/dbp.0b013e318206d5e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed at evaluating the impact of syndromic craniosynostosis on quality of life, assessing the association between the presence of craniosynostosis syndrome and prevalence of behavioral problems and assessing the impact of obstructive sleep apnea (OSA) in syndromic craniosynostosis compared with healthy controls. METHOD A prospective study was carried out using the Obstructive Sleep Apnea-18 (OSA-18) survey and Child Behavior Checklist (CBCL) in 119 syndromic craniosynostosis patients and the OSA-18 survey in 459 controls. The craniosynostosis population underwent a polysomnography to diagnose OSA. RESULTS The total OSA-18 score and scores on the domains sleep disturbance, physical suffering, and caregiver concerns were significantly higher in the craniosynostosis group than in controls. Subgroup analysis revealed behavioral problems in 67% and 50% of boys with Apert and Muenke syndrome, respectively. Correlations between obstructive apnea-hypopnea index and total OSA-18 and CBCL scores were significant. Mean scores for the domains sleep disturbance and physical suffering were significantly higher in moderate OSA. CONCLUSIONS OSA is related with a lower quality of life in children with syndromic craniosynostosis. Behavioral problems were more common in boys with Apert and Muenke syndrome. OSA-18 and CBCL scores were correlated with OSA severity.
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Park Y, Hobar PC, Sinn DP, Peanchitlertkajorn S. Patient with Pfeiffer's syndrome treated by midfacial distraction and comprehensive orthodontics. Am J Orthod Dentofacial Orthop 2011; 139:260-70. [PMID: 21300256 DOI: 10.1016/j.ajodo.2010.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 06/01/2010] [Accepted: 06/01/2010] [Indexed: 11/25/2022]
Abstract
Treatment for patients with craniofacial anomalies always presents a great challenge to orthodontists. Treatment usually requires both comprehensive orthodontic treatment and orthognathic surgery. In this article, we report on a patient with Pfeiffer's syndrome treated by midfacial distraction and comprehensive orthodontics.
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Affiliation(s)
- YongJong Park
- Division of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex., USA
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Reliability and validity of the obstructive sleep apnea-18 survey in healthy children and children with syndromic craniosynostosis. J Dev Behav Pediatr 2011; 32:27-33. [PMID: 21160438 DOI: 10.1097/dbp.0b013e3181fa579f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) affects a person's quality of life. A questionnaire, the OSA-18, is available to measure quality of life in children with OSA not caused by specific craniofacial syndromes. We assessed the internal consistency, test-retest reliability, and discriminative validity of the OSA-18 in children with syndromic and complex craniosynostosis; we also applied the OSA-18 in healthy children to obtain reference values. METHOD The OSA-18 was translated in the Dutch language using the procedure of multiple forward and backward translations. Test-retest reliability and internal consistency were examined. In a prospective study, the craniosynostosis patients underwent an ambulatory polysomnography to diagnose OSA. The ability of the OSA-18 to discriminate between subgroups of patients with or without OSA was evaluated. We compared OSA-18 scores of children with syndromic or complex craniosynostosis with scores in healthy children. RESULTS The Cronbach's alpha was ≥ 0.70 for the total OSA-18 score and for most of the domains in both the craniosynostosis and general population. In the craniosynostosis group, the test-retest intraclass correlation coefficients were ≥ 0.70, except for the domain physical suffering at 0.69. The discriminative validity of the domains sleep disturbance, physical suffering, caregiver concerns, and total OSA-18 score was significant between the general and craniosynostosis population. CONCLUSION This study supports the reliability and validity of the OSA-18 in children with syndromic or complex craniosynostosis.
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Chen CP, Lin SP, Su YN, Chen CY, Tsai FJ, Liu YP, Chern SR, Wu PC, Chen HEC, Wang W. Apert syndrome associated with upper airway obstruction and gastroesophageal reflux inducing polyhydramnios in the third trimester. Taiwan J Obstet Gynecol 2010; 49:231-4. [PMID: 20708539 DOI: 10.1016/s1028-4559(10)60052-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2010] [Indexed: 11/15/2022] Open
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Bannink N, Nout E, Wolvius EB, Hoeve HLJ, Joosten KFM, Mathijssen IMJ. Obstructive sleep apnea in children with syndromic craniosynostosis: long-term respiratory outcome of midface advancement. Int J Oral Maxillofac Surg 2010; 39:115-21. [PMID: 20056390 DOI: 10.1016/j.ijom.2009.11.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 09/30/2009] [Accepted: 11/27/2009] [Indexed: 11/27/2022]
Abstract
Almost 50% of patients with Apert, Crouzon or Pfeiffer syndrome develop obstructive sleep apnea (OSA), mainly due to midface hypoplasia. Midface advancement is often the treatment of choice, but the few papers on long-term outcome report mixed results. This paper aimed to assess the long-term respiratory outcome of midface advancement in syndromic craniosynostosis with OSA and to determine factors contributing to its efficacy. A retrospective study was performed on 11 patients with moderate or severe OSA, requiring oxygen, continuous positive airway pressure (CPAP), or tracheostomy. Clinical symptoms, results of polysomnography, endoscopy and digital volume measurement of the upper airways on CT scan before and after midface advancement were reviewed. Midface advancement had a good respiratory outcome in the short term in 6 patients and was ineffective in 5. In all patients without respiratory effect or with relapse, endoscopy showed obstruction of the rhino- or hypopharynx. The volume measurements supported the clinical and endoscopic outcome. Despite midface advancement, long-term dependence on, or indication for, CPAP or tracheostomy was maintained in 5 of 11 patients. Pharyngeal collapse appeared to play a role in OSA. Endoscopy before midface advancement is recommended to identify airway obstruction that may interfere with respiratory improvement after midface advancement.
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Affiliation(s)
- N Bannink
- Dutch Craniofacial Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands.
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38
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Effect of Midfacial Distraction on the Obstructed Airway in Patients With Syndromic Bilateral Coronal Synostosis. J Oral Maxillofac Surg 2008; 66:2318-21. [DOI: 10.1016/j.joms.2008.06.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 04/25/2008] [Accepted: 06/16/2008] [Indexed: 11/20/2022]
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Pereira V, Sacher P, Ryan M, Hayward R. Dysphagia and nutrition problems in infants with apert syndrome. Cleft Palate Craniofac J 2008; 46:285-91. [PMID: 19642754 DOI: 10.1597/08-010.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify and describe the nature of dysphagia and nutrition difficulties in infants with Apert syndrome. DESIGN The study comprised a review of the medical, nutrition, and feeding records of 13 consecutive infants still feeding by the bottle who had been referred to the Craniofacial Unit and analyses of swallow function from videofluoroscopic swallow investigations. MAIN OUTCOME MEASURES Outcome measures included qualitative analyses of bottle-feeding and nutritional status and quantitative functional severity ratings of dysphagia based on videofluoroscopic swallow investigations using the O'Neil et al. (1999) Dysphagia Outcome Severity Scale. RESULTS The main qualitative descriptors of oral feeding in this cohort included uncoordinated suck-swallow-breathe patterns, inability to maintain sucking bursts, and changes in respiratory patterns as the feed progressed. Videofluoroscopic evaluations (N = 7) showed silent laryngeal penetration or aspiration in more than half of the cohort. Failure to thrive was a frequent occurrence seen in seven infants, and 9 of the 10 required dietetic intervention and enteral supplements. (Nutritional records were not located for three infants.) CONCLUSIONS In view of the small sample size and retrospective nature of the study, the results need to be interpreted with caution. However, the study adds to current limited knowledge on feeding and nutrition in Apert syndrome. Further prospective multidisciplinary and objective research is clearly warranted.
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Vilan Xavier AC, Pinto Silva LC, Oliveira P, Villamarim Soares R, de Almeida Cruz R. A review and dental management of persons with craniosynostosis anomalies. SPECIAL CARE IN DENTISTRY 2008; 28:96-100. [DOI: 10.1111/j.1754-4505.2008.00019.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- C V DeGiovanni
- Department of Dermatology, Worthing and Southlands NHS Trust, Worthing, West Sussex, United Kingdom.
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Shah PS, Siriwardena K, Taylor G, Steele L, Ray P, Blaser S, Chitayat D. Sudden infant death in a patient with FGFR3 P250R mutation. Am J Med Genet A 2007; 140:2794-6. [PMID: 17103449 DOI: 10.1002/ajmg.a.31517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
P250R mutation in the FGFR3 gene also known as Muenke syndrome is associated with coronal craniosynostosis, sensorineural deafness, craniofacial, and digital abnormalities. We report a family with this mutation associated with sudden death in an affected newborn, most probably due to upper airway obstruction.
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Affiliation(s)
- P S Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Thompson DA, Liasis A, Hardy S, Hagan R, Hayward RD, Evans RD, Nischal KK. Prevalence of Abnormal Pattern Reversal Visual Evoked Potentials in Craniosynostosis. Plast Reconstr Surg 2006; 118:184-92. [PMID: 16816694 DOI: 10.1097/01.prs.0000220873.72953.3e] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine the prevalence and type of changes observed in the pattern reversal visual evoked potentials recorded at the first assessment of children with craniosynostosis. METHODS Visual evoked potentials were recorded from 114 patients with craniosynostosis. Eighty-one patients were syndromic and 33 were nonsyndromic. No patient had received any craniofacial surgical intervention. At the time of the test, 22 of 40 patients were aged 6 months and younger, and 18 patients were between 6 months and 1 year of age. Pattern reversal visual evoked potentials were recorded from a midoccipital electrode positioned 3 cm above the inion. The pattern reversal visual evoked potentials elicited to 50' checks with three reversals per second viewed with both eyes were analyzed for n80-p100 amplitude, p100 latency, and breadth of waveform. RESULTS Sixty percent of patients had abnormal pattern reversal visual evoked potentials to 50' checks. This did not show a significant association with age, or classification of craniosynostosis. CONCLUSIONS The high prevalence of abnormal pattern reversal visual evoked potentials to a robust stimulus suggests that visual pathway dysfunction, as measured electrophysiologically, can affect a majority of patients with craniosynostosis. This study indicates that a baseline evaluation of all children with craniosynostosis at their first presentation is essential if subsequent electrophysiologic visual pathway monitoring is to take place.
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Affiliation(s)
- Dorothy A Thompson
- Tony Kriss Visual Electrophysiology Unit and the Department of Ophthalmology, Great Ormond Street Hospital for Children, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom
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Meyer P, Cuttaree H, Blanot S, Orliaguet G, Jarreau MM, Charron B, Perie-Vintras AC, Baugnon T, Carli P. L’Anesthésie-réanimation dans le traitement des craniosténoses. Neurochirurgie 2006; 52:292-301. [PMID: 16981660 DOI: 10.1016/s0028-3770(06)71222-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P Meyer
- Department d'Anesthésie-Réanimation Pédiatrique, Höpital Necker-Enfants Malades-Université René-Descartes/Paris 5, 149, rue de Sèvres, 75743 Paris.
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45
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Affiliation(s)
- D Renier
- Groupe d'Etudes des Malformations Craniofaciales, Service de Neurochirurgie, CHU Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris.
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Balboni AL, Estenson TL, Reidenberg JS, Bergemann AD, Laitman JT. Assessing age-related ossification of the petro-occipital fissure: laying the foundation for understanding the clinicopathologies of the cranial base. ACTA ACUST UNITED AC 2004; 282:38-48. [PMID: 15584035 PMCID: PMC1325220 DOI: 10.1002/ar.a.20149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The petro-occipital fissure (POF) lies within a critical interface of cranial growth and development in the posterior cranial fossa. The relationships between skeletal and soft tissues make this region especially important for examining biomechanical and basic biologic forces that may mold the cranial base and contribute to significant clinicopathologies associated with the structures located near the POF. Therefore, this study investigates the POF in adults in both preserved human cadavers and dried crania in order to determine if developmental changes can be observed and, if so, their value in age assessment as a model system for describing normal morphogenesis of the POF. This study demonstrates that tissue within the POF undergoes characteristic changes in ossification with age, the onset of which is considerably later than that of other synchondroses of the cranial base. Statistically, there is a moderate to strong correlation between age and stage of ossification within the POF. Further, male crania were observed to reach greater degrees of ossification at a younger age than female crania and that individual asymmetry in ossification of the tissue within the POF was not uncommon. An understanding of the basic temporal biological processes of the POF may yield insight into the development of clinicopathologies in this region of the cranial base.
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Affiliation(s)
- Armand L Balboni
- Center for Anatomy and Functional Morphology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Meling TR, Due-Tønnessen BJ, Høgevold HE, Skjelbred P, Arctander K. Monobloc Distraction Osteogenesis in Pediatric Patients With Severe Syndromal Craniosynostosis. J Craniofac Surg 2004; 15:990-1000; discussion 1001. [PMID: 15547389 DOI: 10.1097/00001665-200411000-00020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The management of the hypoplastic midface in syndromic craniosynostosis remains a great challenge. Frequently, patients have to be operated on numerous times to achieve a satisfactory end result, partially because of the limited skeletal advancement possible when using traditional surgical techniques. During the last decade, however, methods for gradual midfacial distraction have been presented, whereby greater advancements can be obtained. We present four children aged 17 months to 15 years with severe syndromal craniosynostosis in need of midface advancements because of severe respiratory obstruction or severe exophthalmos. These patients were complex cases with several previous craniofacial surgeries (mean of three times, range of two to six times) that yielded insufficient skeletal advancements. They were operated on with gradual monobloc advancements using the Modular Internal Distraction System. The mean length of operations was 370 minutes (range: 240-455 minutes), and the mean amount of perioperative blood transfusion needed was 1,300 ml (range: 280-2,700 ml) or 66.9 ml/kg (range: 31.1-94.9 ml/kg). The patient with the greatest number of previous operations also had the longest operation time as well as the most blood loss. The average midface advancement obtained was 25 mm (range: 20-30 mm), resulting in cessation or a significant decrease of preoperative respiratory problems, reduced exophthalmos, and improved facial profile. Apart from a local infection in one patient with a connective tissue disorder and several previous wound infections, no major postoperative complications were recorded. Distraction osteogenesis has become a versatile and safe technique that allows for large advancements of the midface.
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Affiliation(s)
- Torstein R Meling
- Department of Neurosurgery, The National Hospital, University of Oslo, Oslo, Norway.
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Beck R, Sertie AL, Brik R, Shinawi M. Crouzon syndrome: association with absent pulmonary valve syndrome and severe tracheobronchomalacia. Pediatr Pulmonol 2002; 34:478-81. [PMID: 12422346 DOI: 10.1002/ppul.10176] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Airway obstruction is common among patients with craniosynostosis. We describe an infant with a clinical and genetic diagnosis of Crouzon syndrome who presented with respiratory distress and heart murmur in early neonatal life. Cardiac evaluation revealed absent pulmonary valve syndrome. She needed intubation at age 1 month, and repeated trials of extubation failed because of marked respiratory distress, stridor, and severe expiratory obstruction and wheezing. Correction of her cardiac anomaly did not relieve her respiratory distress; only after endobronchial stenting and tracheostomy was it possible to gradually wean her from mechanical ventilation. This case report demonstrates and discusses the different causes of airway obstruction in Crouzon syndrome and the morbidity and mortality that can result from pulmonary involvement in this craniosynostotic syndrome. It also demonstrates the difficult therapeutic challenge created by the combination of cardiopulmonary abnormalities in Crouzon patients.
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Affiliation(s)
- Raphael Beck
- Pediatric Intensive Care Unit, Rambam Medical Center, Haifa, Israel
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Abstract
Craniosynostosis is a congenital developmental disorder involving premature fusion of cranial sutures, often associated with multiple neurological manifestations. The perspective of this group of disorders has changed dramatically in the new era of molecular genetics. In the last decade a large literature with new concepts in craniosynostosis has appeared. More than 100 syndromes associated with craniosynostosis have been described, and in about a dozen, the molecular defect has been identified. Pediatric neurologists are less aware than geneticists, neurosurgeons, and craniofacial surgeons of these changes. General concepts about craniosynostosis are here presented with updates of clinical and genetic aspects of well-defined syndromes such as Apert, Crouzon, Pfeiffer, Saethre-Chotzen. Evidence of their relationship with fibroblast growth factor receptors (FGFRs) 1, 2, and 3, and with causative genes such as TWIST has been documented. New and other less common syndromes also are discussed. The differences between positional and synostotic plagiocephaly are important, as well as the cause of nonsyndromic craniosynostosis. The prognosis and neurological outcome of patients, including "benign" forms of craniosynostosis, are other important aspects. Major advances have occurred in understanding pathogenesis, diagnosis, and treatment of craniosynostosis. The role of local dura mater and apoptosis; modalities of imaging such as prenatal ultrasound and three-dimensional and spiral CT have improved the accuracy in diagnosis, and the new approaches in surgical treatment involving efficient and less invasive methods, are evidence of these advances.
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Affiliation(s)
- Laura Flores-Sarnat
- Department of Pediatrics (Neurology), Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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