Nelson Tyler E, Mulliken John B, Padwa Bonnie L
Harvard School of Dental Medicine, Boston, MA, USA.
J Oral Maxillofac Surg. 2008 Nov;66(11):2318-21. doi: 10.1016/j.joms.2008.06.063.
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.
勒福III型截骨术和面中部前移可扩大鼻咽部，并有可能增加综合征性双侧冠状缝早闭患者的气道尺寸。与传统的一期手术相比，牵张成骨术可实现更大程度的面中部前移，且可能在改善气道阻塞方面更具优势。本研究旨在记录面中部牵张前移对综合征性双侧冠状缝早闭患者气道阻塞的影响。
回顾了接受勒福III型牵张术的综合征性双侧冠状缝早闭患者的病历。对术前和术后的人口统计学、头影测量、多导睡眠图以及患者/家长主观报告的数据进行了回顾。计算描述性和非参数双变量统计数据，以记录气道参数的变化。
在25例行面中部勒福III型牵张术的患者中，只有18例术前存在气道阻塞。气道阻塞患者的平均手术年龄为（±标准差）10.4±4.2岁（范围为2.7至17.4岁），平均前移量为20.5±7.4毫米（范围为10至30毫米）。6例气管切开患者中有5例拔管；1例患者持续存在中枢性呼吸暂停，无法拔管。该组的平均呼吸窘迫指数从33.4±37.57（范围为1.8至109.2）改善至12.6±26.32（范围为0.00至72.0）（P<.05）。9例患者中有6例不再需要持续气道正压通气或双水平气道正压通气。所有患者均报告打鼾减轻（P<.05）。
面中部牵张可改善综合征性双侧冠状缝早闭患者的气道阻塞。临床医生可以告知患者及其家属，该手术通常可实现拔管，并停用持续气道正压通气或双水平气道正压通气。
