Clinical analysis of Le Fort III distraction for obstructive sleep apnea in pediatric patients with syndromic craniosynostosis

Purpose: This study aimed to analyze correlations among respiratory function, upper airway expansion, and the extent of midface advancement in syndromic craniosynostosis patients with obstructive sleep apnea.

Materials and methods: A retrospective study was conducted in 21 children with syndromic craniosynostosis who underwent Le Fort III osteotomy and distractive osteogenesis at the Department of Oral and Maxillofacial Surgery of Peking University International Hospital from October 2017 to December 2022. Computed tomography (CT) data of patients before surgery (T0), 3 months after surgery (T1), and 1 year after surgery (T2) were reviewed. Sleep apnea was evaluated using polysomnography at the corresponding postoperative times. Skeletal changes were evaluated by cephalometric measurements; airway morphology was evaluated by two-dimensional cross square and three-dimensional volume; and respiratory function was measured using the apnea-hypopnea index (AHI), mean oxygen saturation (SpO₂), minimum SpO₂, and the 3% decline in the SpO₂ index. A paired t-test was used to evaluate changes before and after surgery. A P value of <0.05 was considered to indicate statistical significance. Pearson correlation analysis was used to determine correlations among the skeletal structure, airway morphology, and respiratory function.

Results: Significant differences were noted between T0 and T1 in terms of cephalometry landmarks, airway volume, and cross-sectional area (P < 0.05) but not between T1 and T2 (P > 0.05). Similarly, significant differences were detected in AHI, average SpO₂ level, minimum SpO₂ level, and 3% oxygen hypoxia index between T0 and T1 but not between T1 and T2 (P > 0.05). The change in SN-PNS was significantly correlated with an improvement in AHI (P = 0.024) and 3% oxygen hypoxia index (P = 0.019), and the change in palatopharyngeal airway area(Ar B) was significantly correlated with an improvement in minimum SpO₂ (P = 0.018).

Conclusion: Le Fort III osteotomy and distraction are effective in enlarging the upper airway width and improving sleep apnea in syndromic craniosynostosis patients. Cephalometric changes in S-PNS and improvement in Ar B were correlated with long-term improvements in polysomnography outcomes.