Aim: Craniofacial synostosis is characterized by the premature closure of cranial vault sutures and sutures of the anterior cranial fossa, with subsequent hypoplasia and retrusion of midface, usually associated with skull base deformity, laxity and redundancy of pharyngeal soft tissues and adeno-tonsillar hypertrophy. As a result of these morphological alterations, the prevalence of upper airway obstruction and Obstructive Sleep Apnea Syndrome is extremely high in patients with craniofacial synostosis, reaching 50-70%, with significant individual variability in terms of severity of the condition. The international scientific literature is not unanimous in evaluating results regarding the effectiveness of midfacial advancement for the treatment of OSAS in patients affected by craniofacial synostosis. This study aims to evaluate the correlation between midface skeletal movements and anatomical changes in airways, as well as changes in the polysomnographic parameters, in patients affected by craniofacial synostosis. Material and methods: 15 patients affected by craniofacial synostosis who underwent a Le Fort III osteotomy with classic technique or osteodistraction were included. For each patient, lateral standardized cephalometric X-Ray and polysomnography were collected before and after surgery. Changes between pre-and post-operative cephalometric and polysomnografic parameters were then evaluated. Results: Skeletal changes obtained with Le Fort III osteotomy were all highly statistically significant as well as the improvement in polysomnografic parameters. Conclusions: This study confirms that Le Fort III osteotomy has a positive effect on OSAS due to an effective advancement of midface. However, we should always consider that an important role in the genesis of OSAS is played also by soft-tissue tone, adeno-tonsillar hypertrophy and oropharyngeal stenosis.
Obiettivi: Le craniofaciostenosi sono caratterizzate dalla chiusura precoce delle suture della volta cranica e delle suture della fossa cranica anteriore, con conseguente ipoplasia e retrusione della terzo facciale medio, solitamente associata a deformità della base cranica, lassità e ridondanza dei tessuti molli faringei e ipertrofia adeno-tonsillare. A causa di queste alterazioni morfologiche, la prevalenza dell'ostruzione delle vie aeree superiori e della sindrome delle apnee ostruttive nel sonno è estremamente elevata nei pazienti con sinostosi cranio-facciale, raggiungendo il 50-70%. La letteratura internazionale non è unanime nel valutare i risultati relativi all'efficacia dell'avanzamento del terzo medio facciale per il trattamento dell'OSAS nei pazienti affetti da craniofaciostenosi. Il presente studio si propone di valutare la correlazione tra i movimenti dello scheletro del terzo medio facciale e i cambiamenti anatomici delle vie aeree, nonché le variazioni dei parametri polisonnografici, nei pazienti affetti da sinostosi cranio-facciale. Materiali e metodi: sono stati inclusi 15 pazienti affetti da sinostosi cranio-facciale, sottoposti a osteotomia di tipo Le Fort III con tecnica classica o osteodistrazione. Per ogni paziente, sono state raccolte teleradiografie cefalometriche laterali standardizzate e polisonnografie prima e dopo l'intervento. Sono state quindi valutate le variazioni tra i parametri cefalometrici e polisonnografici pre- e post-operatori. Risultati: I cambiamenti scheletrici ottenuti con l'osteotomia Le Fort III sono stati tutti altamente significativi dal punto di vista statistico, così come il miglioramento dei parametri polisonnografici. Conclusioni: Questo studio conferma che l'osteotomia di tipo Le Fort III ha un effetto positivo sull'OSAS grazie a un efficace avanzamento del terzo medio facciale. Tuttavia, dobbiamo sempre considerare che un ruolo importante nella genesi dell'OSAS è svolto anche dal tono dei tessuti molli, dall'ipertrofia adeno-tonsillare e dalla stenosi orofaringea.
Effects of midfacial advancement on obstructive sleep apnea in craniofacial synostosis
CAVADINI, GIULIA
2023/2024
Abstract
Aim: Craniofacial synostosis is characterized by the premature closure of cranial vault sutures and sutures of the anterior cranial fossa, with subsequent hypoplasia and retrusion of midface, usually associated with skull base deformity, laxity and redundancy of pharyngeal soft tissues and adeno-tonsillar hypertrophy. As a result of these morphological alterations, the prevalence of upper airway obstruction and Obstructive Sleep Apnea Syndrome is extremely high in patients with craniofacial synostosis, reaching 50-70%, with significant individual variability in terms of severity of the condition. The international scientific literature is not unanimous in evaluating results regarding the effectiveness of midfacial advancement for the treatment of OSAS in patients affected by craniofacial synostosis. This study aims to evaluate the correlation between midface skeletal movements and anatomical changes in airways, as well as changes in the polysomnographic parameters, in patients affected by craniofacial synostosis. Material and methods: 15 patients affected by craniofacial synostosis who underwent a Le Fort III osteotomy with classic technique or osteodistraction were included. For each patient, lateral standardized cephalometric X-Ray and polysomnography were collected before and after surgery. Changes between pre-and post-operative cephalometric and polysomnografic parameters were then evaluated. Results: Skeletal changes obtained with Le Fort III osteotomy were all highly statistically significant as well as the improvement in polysomnografic parameters. Conclusions: This study confirms that Le Fort III osteotomy has a positive effect on OSAS due to an effective advancement of midface. However, we should always consider that an important role in the genesis of OSAS is played also by soft-tissue tone, adeno-tonsillar hypertrophy and oropharyngeal stenosis.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/17493