Kouga Takeshi, Tanoue Koji, Matsui Kiyoshi
From the Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan.
J Craniofac Surg. 2014 May;25(3):762-5. doi: 10.1097/SCS.0000000000000763.
Syndromic craniosynostosis is associated with a high rate of respiratory difficulty, due mainly to midfacial hypoplasia. Nasopharyngeal airway establishment has been reported as the first-line approach to airway obstruction and may obviate the need for a highly invasive tracheotomy. No previous studies have compared airway obstruction status in syndromic craniosynostosis between cases requiring and not requiring airway managements. We focus on nasopharyngeal airway use and airway status outcomes to assess respiratory difficulty in patients with syndromic craniosynostosis. A retrospective data analysis of 51 cases with syndromic craniosynostosis was carried out. We divided 30 of the 51 cases with lateral pharyngeal x-rays taken before operations affecting airway diameters into 2 groups, one with neither nasopharyngeal airway insertion nor tracheotomy and the other with one or both of these interventions, and the mean diameters for 8 indices related to the pharyngeal space were compared. Cases with respiratory difficulty due to nasopharyngeal stenosis and requiring airway managements comprised a significantly higher proportion of those with Pfeiffer syndrome than patients with Crouzon or Apert syndrome. Comparative examination of lateral x-ray cephalometry between cases with neither nasopharyngeal airway insertion nor tracheotomy and cases with one or both revealed oropharyngeal diameters tended to be smaller in those with interventions. Cases requiring nasopharyngeal airway insertion were able to continue nasopharyngeal airway use for more than 1 year and a considerable number avoided tracheotomy. It may be worth considering an oropharyngeal-bypass nasopharyngeal airway before performing a tracheotomy.
综合征性颅缝早闭与高呼吸困难发生率相关，主要由于面中部发育不全。据报道，建立鼻咽气道是气道阻塞的一线治疗方法，可能避免进行高侵入性的气管切开术。此前尚无研究比较需要和不需要气道管理的综合征性颅缝早闭病例的气道阻塞状况。我们聚焦于鼻咽气道的使用情况和气道状况结果，以评估综合征性颅缝早闭患者的呼吸困难情况。对51例综合征性颅缝早闭病例进行了回顾性数据分析。我们将51例术前拍摄了影响气道直径的侧位咽部X线片的病例中的30例分为两组，一组既未插入鼻咽气道也未进行气管切开术，另一组进行了其中一项或两项干预措施，并比较了与咽腔相关的8个指标的平均直径。因鼻咽狭窄导致呼吸困难且需要气道管理的病例中，患有 Pfeiffer 综合征的患者比例显著高于患有 Crouzon 或 Apert 综合征的患者。对既未插入鼻咽气道也未进行气管切开术的病例与进行了其中一项或两项干预措施的病例的侧位X线头影测量进行对比检查发现，接受干预的病例的口咽直径往往较小。需要插入鼻咽气道的病例能够持续使用鼻咽气道超过1年，并且相当数量的病例避免了气管切开术。在进行气管切开术之前，考虑使用口咽旁路鼻咽气道可能是值得的。
