S12-17 SESSION 12: FACIOCRANIOSYNOSTOSIS – PART II PAN-FACIAL DISTRACTION FOR SEVERE CRANIO-MAXILLOFACIAL RETRUSION:

Abstract

Introduction: Monobloc distraction can effectively improve patients with severe cranio-maxillofacial retrusion suffering from increased intra-cranial pressure, orbital proptosis and obstructive sleep apnea. In these patients, their mandibles may look normal or even protrusive. However, at the end of the monobloc distraction advancement, their mandibles commonly become retrusive when compared with the forwarded distracted midface. Their obstructive sleep apnea might not improve as the retro-lingual airway becomes the bottle-neck. The aim of the presentation is to present a new concept of pan-facial distraction for cranio-synostosis children suffering from severe cranio-maxillofacial retrusion. Methods: Children with typical midfacial depression, orbital proptosis and increased intra-cranial pressure having confirmed cranio-synostosis will go through a full upper airway assessment by a combination of CT scan, computerized airway measurement and sleep endoscopic evaluation. The upper airway at different levels (naso-pharyngeal, uvula, base of tongue, larynx) were measured in transverse and antero-posterior planes as well as Volumatic measurement of airway volume. When the upper airway at the nasopharynx, retro-uvula and retro-lingual dimensions were restricted, pan-facial distraction by means of simultaneous mono-bloc and mandibular distraction was performed with a combination of external and internal distractors. Results: Clinical cases will be presented to illustrate the clinical improvement that can be achieved when this concept was implemented in children with syndromal craniosynostosis. Conclusion: Pan-facial distraction is effective in alleviating the obstructive sleep apnea syndrome of children with syndromal craniosynostosis suffering from multiple levels of airway obstruction.