颅缝早闭患者的气道异常。
Airway anomalies in patients with craniosynostosis.
机构信息
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A.
出版信息
Laryngoscope. 2019 Nov;129(11):2594-2602. doi: 10.1002/lary.27589. Epub 2018 Nov 19.
OBJECTIVES
- Characterize the spectrum of airway anomalies in patients with craniosynostosis, and 2) identify clinical characteristics of these patients that may be associated with the development of airway anomalies.
METHODS
This study is a retrospective case series assessing the type and frequency of airway anomalies in all patients with craniosynostosis seen at a tertiary-care children's hospital between 2000 and 2016. Cohort analyses were then performed to identify differences in airway anomalies dependent on syndromic associations, multisutural fusion, and location of suture fusion. Clinical characteristics examined included demographics and additional neurologic and craniofacial abnormalities.
RESULTS
Four hundred and ninety-six patients with craniosynostosis (83.5% white, 64.5% male; 33.9% sagittal, 28.8% metopic, 11.5% coronal, 1.2% lambdoid, and 24.6% multisutural) were included. Notable airway anomalies included the following: 13.3% adenotonsillar hypertrophy, 8.9% laryngomalacia, 7.3% tracheomalacia, 7.1% subglottic stenosis, 4.0% bronchomalacia, 3.8% laryngeal cleft, and 1.2% vocal fold paresis. Multisutural craniosynostosis patients (n = 122) were more likely to have obstructive sleep apnea (P = 0.005), adenotonsillar hypertrophy (P = 0.014), tracheomalacia (P = 0.011), subglottic stenosis (P < 0.001), and epiglottic/base of tongue collapse (P = 0.003) and require tracheostomy (P = 0.001) and mechanical ventilation (P = 0.017) compared with single suture craniosynostosis. Syndromic craniosynostosis patients (n = 33) were more likely to have obstructive sleep apnea (P < 0.001), laryngomalacia (P = 0.047), and subglottic stenosis (P = 0.009) compared with nonsyndromic patients.
CONCLUSION
Airway anomalies are prevalent in patients with craniosynostosis; patients with multisutural or syndromic types have an increased risk of developing certain abnormalities. There should be a lower threshold for referral for airway evaluation in these populations.
LEVEL OF EVIDENCE
- Laryngoscope, 129:2594-2602, 2019.
目的
1）描述颅缝早闭患者气道异常的范围，2）确定这些患者的临床特征，这些特征可能与气道异常的发展有关。
方法
本研究是一项回顾性病例系列研究，评估了 2000 年至 2016 年间在一家三级儿童医院就诊的所有颅缝早闭患者的气道异常类型和频率。然后进行队列分析，以确定与综合征相关性、多缝融合以及缝融合部位相关的气道异常差异。检查的临床特征包括人口统计学特征以及其他神经和颅面异常。
结果
共纳入 496 例颅缝早闭患者（83.5%为白人，64.5%为男性；33.9%为矢状缝早闭，28.8%为额缝早闭，11.5%为冠状缝早闭，1.2%为人字缝早闭，24.6%为多缝早闭）。显著的气道异常包括：13.3%的腺样体扁桃体肥大，8.9%的喉软化，7.3%的气管软化，7.1%的声门下狭窄，4.0%的支气管软化，3.8%的喉裂，1.2%的声带麻痹。多缝颅缝早闭患者（n=122）更易发生阻塞性睡眠呼吸暂停（P=0.005）、腺样体扁桃体肥大（P=0.014）、气管软化（P=0.011）、声门下狭窄（P<0.001）、会厌/舌根塌陷（P=0.003），需要气管切开术（P=0.001）和机械通气（P=0.017），而单缝颅缝早闭患者则较少见。综合征性颅缝早闭患者（n=33）更易发生阻塞性睡眠呼吸暂停（P<0.001）、喉软化（P=0.047）和声门下狭窄（P=0.009），与非综合征性患者相比。
结论
气道异常在颅缝早闭患者中很常见；多缝或综合征型患者发生某些异常的风险增加。这些人群气道评估的转诊门槛应更低。
证据水平
4.《喉镜》，129：2594-2602，2019。
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