Effect of Midfacial Distraction on the Obstructed Airway in Patients With Syndromic Bilateral Coronal Synostosis

Abstract

Le Fort III osteotomy and midfacial advancement expand the nasopharynx and potentially increase airway dimensions in patients with syndromic bilateral coronal synostosis. Distraction osteogenesis allows greater midfacial advancement, and may offer more improvement in airway obstruction, compared with the conventional 1-stage procedure. This study aimed to document the effect of midfacial distraction-advancement on airway obstruction in patients with syndromic bilateral coronal synostosis. Charts of patients with syndromic bilateral coronal synostosis who had undergone Le Fort III distraction were reviewed. Preoperative and postoperative demographic, cephalometric, polysomnographic, and subjective patient/parental reported data were reviewed. Descriptive and nonparametric bivariate statistics were computed, to document changes in airway parameters. Of 25 patients who underwent midfacial Le Fort III distraction, only 18 had preoperative airway obstruction. The mean age at operation for patients with airway obstruction was (+/-SD) 10.4 +/- 4.2 years (range, 2.7 to 17.4 years), and the average advancement was 20.5 +/- 7.4 mm (range, 10 to 30 mm). Five of 6 patients with a tracheostomy were decannulated; 1 patient had persistent central apnea that prevented decannulation. The mean respiratory distress index for the group improved from 33.4 +/- 37.57 (range, 1.8 to 109.2) to 12.6 +/- 26.32 (range, 0.00 to 72.0) (P < .05). Six of 9 patients no longer required continuous or bilevel positive airway pressure. All patients reported decreased snoring (P < .05). Midfacial distraction improves airway obstruction in patients with syndromic bilateral coronal synostosis. Clinicians can counsel patients and families that this procedure usually permits decannulation and discontinuation of continuous or bilevel positive airway pressure.