Brown Kathryn W, Edwards Shelley R, Hoppe Ian C
Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Neuroscience, School of Graduate Studies in Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA.
Craniomaxillofac Trauma Reconstr. 2023 Dec;16(4):301-305. doi: 10.1177/19433875221142676. Epub 2022 Nov 28.
Retrospective observational study.
The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement.
After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care.
Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation.
The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.
回顾性观察研究。
本出版物的目的是解决缺乏文献详细描述综合征性颅缝早闭和阻塞性睡眠呼吸暂停患者在LeFort III推进并放置牵引装置后的术后即刻但在足够的面中部推进之前的呼吸管理情况。
经机构审查委员会批准后，研究人员回顾性选择纳入本病例系列的候选人。样本由在一家三级医疗中心一年期间接受LeFort III面中部推进的4名年龄在10至19岁之间的患者组成。所有手术均由一名外科医生进行。经多导睡眠图测定，所选的4名患者中有3名患有严重的阻塞性睡眠呼吸暂停，需要进行手术。一名患者术后持续出现呼吸暂停，需要长时间在重症监护病房护理。
4名患者中有3名经多导睡眠图诊断为重度阻塞性睡眠呼吸暂停，平均每小时呼吸暂停低通气指数为28.3。3名术前患有阻塞性睡眠呼吸暂停的患者中有2名在术后即刻未出现不良呼吸并发症；1名需要每晚使用氧气帐，另1名不需要补充氧气。患者1术后出现严重的呼吸窘迫，每晚有呼吸暂停发作和血氧饱和度下降，需要补充氧气和频繁刺激。
本研究表明，睡眠医学的早期介入和患者期望的管理至关重要。在重症监护病房进行极其密切的术后监测是必要的。需要进一步研究制定在面中部推进开始和完成之前接受LeFort III截骨术的阻塞性睡眠呼吸暂停患者围手术期管理方案。
