3D-CT measurements of Airway Morphology in Severe CFM Patients: A comparative study between ascending ramus distraction osteogenesis and Bone Grafting

Abstract

This study investigated the differential effects of mandibular distraction osteogenesis (MDO) and bone grafting on upper airway morphology in pediatric patients with Pruzansky-Kaban type IIB and III craniofacial microsomia (CFM). A retrospective analysis was performed on medical records and three-dimensional computed tomography (3D-CT) scans of CFM patients who had undergone MDO or bone grafting as primary interventions. Preoperative and postoperative imaging data were evaluated to quantify and compare changes in airway dimensions between the two surgical groups. Parameters such as airway volume, surface area, length, mean and minimum cross-sectional areas, and sphericity were measured across the nasopharynx, oropharynx, and laryngopharynx. Data normality was assessed using the Shapiro-Wilk test, and statistical comparisons were made using either paired t-tests or the Wilcoxon signed-rank test, depending on distribution characteristics. Eighteen children with type IIB and III CFM were included in the study, with 11 undergoing MDO and 7 receiving bone grafting. In the MDO group, postoperative measurements revealed significant increases in nasopharyngeal length and surface area (P=0.001, P=0.036), along with notable improvements in oropharyngeal length, volume, surface area, mean and minimum cross-sectional areas, and sphericity (P<0.05). In contrast, the bone grafting group exhibited a significant increase only in nasopharyngeal length (P=0.019), without substantial postoperative changes in other airway parameters. These findings suggested that MDO leads to more pronounced improvements in upper airway morphology, particularly in the nasopharynx and oropharynx, compared to bone grafting, which demonstrated minimal impact on airway dimensions.