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Guérin J, Hennocq Q, Paternoster G, Arnaud É, Khonsari RH. Distractor position and distraction amplitude in fronto-facial monobloc advancement : A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101942. [PMID: 38897383 DOI: 10.1016/j.jormas.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of faciocraniosynostoses. In techniques with internal distraction, two sets of devices are generally positioned: bilateral fronto-orbital and temporo-zygomatic distractors, using a temporal tongue and groove osteotomy design. It is believed that distractors must be positioned as parallel as possible in the horizontal and sagittal planes to avoid mechanical conflicts between the sliding bone fragments of the tongue and groove during distraction, and thus optimize the advancement amplitude. Several approaches involving surgical planification and guides for distractor positioning have thus been proposed to monitor distractor placement. To explore the need for surgical planification in distractor placement, the parallelism of the position of the 4 distractors was assessed in 19 FFMBA procedures and we correlated a set of 10 distractor angles with the degree of advancement. We report that the horizontal cut of the tongue and groove can be used as a landmark for the positioning of the lower, temporo-zygomatic, distractor in fronto-facial monobloc advancement. Other parameters (relative position of the two homolateral and the two contralateral distractors and the orientations of the vertical and horizontal cuts of the tongue and groove) do not interfere with distraction, other things being equal. Our results indicate that distractor orientation is not a critical issue in fronto-facial monobloc advancement when devices are positioned as parallel as possible based on visual monitoring.
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Affiliation(s)
- Jade Guérin
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Quentin Hennocq
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Éric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France; Clinique Marcel Sembat, Ramsay, Boulogne-Billancourt, France
| | - Roman Hossein Khonsari
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France.
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Huang Y, Yang Q. Apert syndrome and obstructive sleep apnea: Timing for midface surgery. Cranio 2024:1-12. [PMID: 39267323 DOI: 10.1080/08869634.2024.2398739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
OBJECTIVE This study aims to determine the optimal timing for midface surgery in patients with Apert syndrome and Obstructive Sleep Apnea (OSA). METHODS We reviewed relevant articles from Web of Science and PubMed and conducted a bibliometric analysis. RESULTS A review of 74 documents published between 1981 and 2023 revealed that determining the optimal timing for surgery in cases of airway obstruction necessitates consideration of various factors, including the location and severity of airway abnormalities, craniofacial development, potential impact of treatment on future growth, psychological considerations, and overall physiological conditions. Although midface advancement surgery performed around ages 6 to 7 typically yields symptom relief and favorable long-term outcomes, the ideal surgical timing young children with severe OSA remains a contentious issue. CONCLUSION While midface surgery is frequently advocated at ages 6 to 7, there is an urgent need for enhanced cooperation and high-quality research to deepen our understanding.
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Affiliation(s)
- Ying Huang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Chang Y, Yu Y, Zhang W, Gao Y, Feng J, Li M, Han F. The effect of continuous positive airway pressure on obstructive sleep apnea in children with syndromic craniosynostosis. Sleep Breath 2024; 28:1439-1448. [PMID: 38180682 PMCID: PMC11196332 DOI: 10.1007/s11325-023-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is common in children with syndromic craniosynostosis (SC). However, objective data on the treatment of OSA in children with SC remain inadequate. This study aimed to explore the efficacy of continuous positive airway pressure (CPAP) in the management of OSA in children with SC. METHODS A retrospective study was performed in children with SC and OSA diagnosed by polysomnography (PSG), which was defined as an apnea hypopnea index (AHI) ≥ 1. Patients were included if they were treated with CPAP and had baseline PSG and follow-up sleep studies. Clinical and demographic data were collected from all enrolled subjects. RESULTS A total of 45 children with SC and OSA were identified, with an average age of 6.8 ± 4.7 years. Among them, 36 cases had moderate to severe OSA (22 with severe OSA) and received CPAP therapy followed by post-treatment sleep studies. Notably, there was a significant reduction in the AHI observed after CPAP treatment (3.0 [IQR: 1.7, 4.6] versus 38.6 [IQR: 18.2, 53.3] events/h; P < 0.001). CONCLUSIONS CPAP is effective and acceptable in treating severe OSA in children with SC.
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Affiliation(s)
- Yuan Chang
- Department of Sleep Medicine, Peking University Pepole's Hospital, 11 Xizhimennan Road, Beijing, 100044, China
| | - Yongbo Yu
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Wei Zhang
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Yinghui Gao
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Junjun Feng
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Mengjie Li
- Sleep Center, Peking University International Hospital, Beijing, China
| | - Fang Han
- Department of Sleep Medicine, Peking University Pepole's Hospital, 11 Xizhimennan Road, Beijing, 100044, China.
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Burns HR, Wang DS, Abu-Ghname A, Dempsey RF. Craniofacial Distraction Osteogenesis. Semin Plast Surg 2023; 37:253-264. [PMID: 38098686 PMCID: PMC10718658 DOI: 10.1055/s-0043-1776298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Distraction osteogenesis (DO) of the craniofacial skeleton has become an effective technique for the treatment of both nonsyndromic and syndromic conditions. The advent of craniofacial DO has allowed for earlier intervention in pediatric patients with less complication risk and morbidity compared to traditional techniques. In this review, we will discuss current application and technique for craniofacial DO by anatomical region and explore future applications in craniofacial surgery.
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Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Daniel S. Wang
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Amjed Abu-Ghname
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F. Dempsey
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Raposo-Amaral CE. Discussion: Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification. Plast Reconstr Surg 2023; 152:623-627. [PMID: 37647375 DOI: 10.1097/prs.0000000000010538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Cassio Eduardo Raposo-Amaral
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital
- Department of Neurology, University of Campinas
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Chen K, Kondra K, Nagengast E, Hammoudeh JA, Urata MM. Syndromic Synostosis: Frontofacial Surgery. Oral Maxillofac Surg Clin North Am 2022; 34:459-466. [PMID: 35786530 DOI: 10.1016/j.coms.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Frontofacial surgery, encompassing the monobloc with or without facial bipartition and the box osteotomy, can treat the frontal bone and midface simultaneously, providing comprehensive improvement in facial balance. Complex pediatric patients with genetic syndromes and craniosynostosis are most optimized by an interdisciplinary team of surgeons, pediatricians, geneticists, speech pathologists, audiologists, dietitians, pediatric dentists, orthodontists, and psychosocial support staff to manage the myriad of challenges and complications throughout early childhood and beyond. Despite early treatment of the anterior and posterior cranial vault, these patients frequently have resultant frontal and/or midface hypoplasia and orbital abnormalities that are best managed with simultaneous surgical treatment.
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Affiliation(s)
- Kevin Chen
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA
| | - Eric Nagengast
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA; Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA; Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA.
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 West Sunset Boulevard, Mailstop 96, Los Angeles, CA 90027, USA; Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, 1520 San Pablo Street, Los Angeles, CA 90033, USA; Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
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