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Evaluating the Efficacy of Airway Expansion Using Trans-cranial Versus Sub-cranial Facial Osteotomies: A Cohort Comparison Study Between Monobloc Frontofacial Advancement and Le Fort III Facial Advanc
Oluwaseun A. Adetayo, MD, S Alex Rottgers,MD, Lino Miele, MD, Zoe Macisaac, BS MD, Edward Davidson MD, Anand Kumar, MD
University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC
2013-03-07
Presenter: Oluwaseun A Adetayo
Affidavit:
The project above is the original work of the presenting fellow and faculty listed including project inception, study design, data analysis, and final editing.
Director Name: Joseph E. Losee
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Differential airway volume expansion comparing transcranial versus subcranial facial advancement procedures remains understudied. The aim of this study is to compare differences in airway changes between monobloc/bipartition advancements (group 1) versus Lefort III advancements (Group 2).
Methods: A 16-month retrospective cohort study comparing airway changes in both groups using radiographic data (total airway volume (TAV), nasopharyngeal airway volume (NAV), oropharyngeal airway volume (OAV), and minimal airway areas in the nasopharynx and oropharynx was performed.
Results: In Group 1, four patients (1 female, 3 males, all syndromic) and in Group 2, three patients (3 males, all syndromic) were identified. Average age was 8.9 years in Group 1 and 15 years in Group 2 (p=0.13). The average radiographic advancement (body of C2-A) was 12.4mm (10-17) in Group 1 and 12.27 mm (9.9-14.3) in Group 2 (p=0.14). The minimal nasopharyngeal airway area increased in Group 1 (63.7mm2 to 194.6mm2, p=0.068) and in Group 2 (59.6mm2 to 104mm2, p=0.109). The minimal oropharyngeal airway did not significantly change in Group 1 (56.4 mm2 to 74.4 mm2, p=0.144) or Group 2 (89.4 mm2 to 108.4 mm2, p=0.109). All patients in both groups demonstrated resolution of clinical airway obstruction.
Conclusions: Airway changes were similarly expanded using either a transcranial or subcranial advancement. Transcranial expansion should be considered for the treatment of concurrent cranial constriction, as both expansions are equally effective treatment for nasopharyngeal airway expansion.
